Healthcare Provider Details

I. General information

NPI: 1457348450
Provider Name (Legal Business Name): COLONIAL CARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 03/22/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 E JONES ST
CHOUTEAU OK
74337-2839
US

IV. Provider business mailing address

113 E JONES ST
CHOUTEAU OK
74337-2839
US

V. Phone/Fax

Practice location:
  • Phone: 918-476-8918
  • Fax: 918-476-8960
Mailing address:
  • Phone: 918-476-8918
  • Fax: 918-476-8960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH4903
License Number StateOK

VIII. Authorized Official

Name: MICHAEL BRANDON MORGAN
Title or Position: PRESIDENT
Credential:
Phone: 918-235-6443