Healthcare Provider Details

I. General information

NPI: 1346247822
Provider Name (Legal Business Name): IHS BALLARD NURSING CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 07/21/2022
Certification Date: 04/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W 5TH ST
ADA OK
74820-3415
US

IV. Provider business mailing address

201 W 5TH ST
ADA OK
74820-3415
US

V. Phone/Fax

Practice location:
  • Phone: 580-436-0950
  • Fax: 580-436-0953
Mailing address:
  • Phone: 580-436-0950
  • Fax: 580-436-0953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateOK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier100777750A
Identifier TypeMEDICAID
Identifier StateOK
Identifier Issuer

VIII. Authorized Official

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