Redwood Place Living Center

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

License

NH3211-3211 Issued in OK

Legal business name

REDWOOD PLACE LIVING CENTER

Practice address

623 S Alabama St
Wetumka, OK 74883-6034

Phone

(405) 452-3271

Fax

(405) 452-5154

NPI assigned

Oct 4, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Donna R Simmons

Title

Office Manager

Phone

(405) 786-2266

Specialties & licenses 1

Addresses

Other names 1

• Adkins, LP dba Redwood Place Former legal business name

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Brandon King, D.O.

  • Family Medicine Physician
  • Gore, OK
  • NPI 1609173038
  NPD (past)
• Angela Marie McGuire, D.O.

  • General Practice Physician
  • Oklahoma City, OK
  • NPI 1053492256
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1912092602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 488",
            "city": "WELEETKA",
            "state": "OK",
            "postal_code": "748800488",
            "telephone_number": "405-786-2266",
            "fax_number": "405-786-2388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "623 S ALABAMA ST",
            "city": "WETUMKA",
            "state": "OK",
            "postal_code": "748836034",
            "telephone_number": "405-452-3271",
            "fax_number": "405-452-5154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REDWOOD PLACE LIVING CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SIMMONS",
        "authorized_official_first_name": "DONNA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "405-786-2266",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "OK",
            "license": "NH3211-3211",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Adkins, LP dba Redwood Place",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Pioneer Living Center Ops LLC
• Pioneer Living Center Ops LLC
• Pioneer Living Center Ops LLC
• Pioneer Living Center Ops LLC
• Pioneer Living Center Ops LLC
• Debra Jane Richardson, M.ED
• Tyler Drug
• Christopher Jason Tyler, RPH
• Hetlevia R Vilar-Jensen, M.D.
• Wetumka Indian Health Clinic

• Intellectual Disabilities Intermediate Care Facility in Wetumka, OK
• Providers in Wetumka, OK by specialty
• Intellectual Disabilities Intermediate Care Facility in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.