Healthcare Provider Details

I. General information

NPI: 1699756403
Provider Name (Legal Business Name): BEAVER COUNTY NURSING HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 08/05/2024
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 EAST 8TH STREET
BEAVER OK
73932
US

IV. Provider business mailing address

PO BOX 220
BEAVER OK
73932-0220
US

V. Phone/Fax

Practice location:
  • Phone: 580-625-4571
  • Fax: 580-625-4891
Mailing address:
  • Phone: 580-625-4571
  • Fax: 580-625-4891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License NumberNH0401-0401
License Number StateOK

VIII. Authorized Official

Name: ARLENE LAROYCE BROWN
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 580-625-4571