Healthcare Provider Details

I. General information

NPI: 1518969781
Provider Name (Legal Business Name): INDIAN NATIONS HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 JONES ST
BROKEN BOW OK
74728-5304
US

IV. Provider business mailing address

700 JONES ST
BROKEN BOW OK
74728-5304
US

V. Phone/Fax

Practice location:
  • Phone: 580-584-6433
  • Fax: 580-584-2014
Mailing address:
  • Phone: 580-584-6433
  • Fax: 580-584-2014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. GIELA RAYE WILLIAMS
Title or Position: ADMINISTRATOR
Credential: REGISTERED NURSE
Phone: 580-584-6433