Ok4 Eastgate Opco LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

OK4 EASTGATE OPCO LLC

Practice address

3500 Haskell Blvd
Muskogee, OK 74403-3915

Phone

(918) 682-3191

NPI assigned

May 3, 2016

Organization subpart

No

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

Authorized official

Name

Isaac Dole

Title

Manager/Principal

Phone

(773) 645-9246

Specialties & licenses 1

Addresses

Other names 1

• Eastgate Village Retirement Center Doing business as

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

{
    "created_epoch": "1462233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730160000000",
    "number": "1962857482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3500 HASKELL BLVD",
            "city": "MUSKOGEE",
            "state": "OK",
            "postal_code": "744033915",
            "telephone_number": "918-682-3191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3500 HASKELL BLVD",
            "city": "MUSKOGEE",
            "state": "OK",
            "postal_code": "744033915",
            "telephone_number": "918-682-3191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OK4 EASTGATE OPCO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-03",
        "last_updated": "2024-10-29",
        "certification_date": "2024-10-29",
        "status": "A",
        "authorized_official_last_name": "DOLE",
        "authorized_official_first_name": "ISAAC",
        "authorized_official_title_or_position": "MANAGER/PRINCIPAL",
        "authorized_official_telephone_number": "773-645-9246"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OK",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eastgate Village Retirement Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Muskogee, OK
• Providers in Muskogee, OK by specialty
• Skilled Nursing Facility in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2024; 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.