Healthcare Provider Details

I. General information

NPI: 1356382899
Provider Name (Legal Business Name): JACKSON COUNTY MEMORIAL HOSPITAL SKILLED NURSING FACILITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E PECAN ST
ALTUS OK
73521-6141
US

IV. Provider business mailing address

1200 E PECAN ST
ALTUS OK
73521-6141
US

V. Phone/Fax

Practice location:
  • Phone: 580-379-5000
  • Fax: 580-379-5509
Mailing address:
  • Phone: 580-379-5000
  • Fax: 580-379-5509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2206
License Number StateOK

VIII. Authorized Official

Name: MR. STEVE HARTGRAVES
Title or Position: PRESIDENT/CEO
Credential:
Phone: 580-379-5500