MEDICARE: HASKELL CARE CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	NH5104-5104	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891795100
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HASKELL CARE CENTER LLC

Provider Business Mailing Address
First Line	:	405 N CHOCTAW AVENUE
Second Line	:
City	:	HASKELL
State	:	OK
Zip	:	74436-1319
Country	:	US
Telephone Number	:	918-482-3310
Fax Number	:	918-482-6901

Provider Business Practice Location Address
First Line	:	405 N CHOCTAW AVENUE
Second Line	:
City	:	HASKELL
State	:	OK
Zip	:	74436-1319
Country	:	US
Telephone Number	:	918-482-3310
Fax Number	:	918-482-6801

Authorized Official
Title or Position	:	OWNER
Name	:	PAM HUMPHREYS
Credential	:
Telephone Number	:	405-379-0039

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	01/06/2025

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