NPI 1083663512 · live from the CMS NPI Registry
Eastgate Village LLC
Skilled Nursing Facility in Muskogee, OK. National Provider Identifier 1083663512, active.
NPI record
| NPI | 1083663512 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Skilled Nursing Facility 314000000X |
| Practice location | 3500 Haskell Blvd, Muskogee, OK 74403 |
| Practice phone | 918-682-3191 |
| Enumerated | May 10, 2006 |
| Last updated | September 11, 2025 |
| Authorized official | Mary Fletcher, Administrator |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Nursing Facility/Intermediate Care Facility | 313M00000X | NH5113-5113 (OK) |
| Skilled Nursing Facility primary | 314000000X | NH5113-5113 (OK) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.