Healthcare Provider Details

I. General information

NPI: 1982836136
Provider Name (Legal Business Name): ADA CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2009
Last Update Date: 04/07/2020
Certification Date: 04/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 N COUNTRY CLUB RD
ADA OK
74820-2845
US

IV. Provider business mailing address

931 N COUNTRY CLUB RD
ADA OK
74820-2845
US

V. Phone/Fax

Practice location:
  • Phone: 580-332-3631
  • Fax:
Mailing address:
  • Phone: 580-332-3631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License NumberNH6201-6201
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH6201-6201
License Number StateOK

VIII. Authorized Official

Name: BART REED
Title or Position: MANAGER
Credential:
Phone: 580-436-0950