Healthcare Provider Details

I. General information

NPI: 1497872717
Provider Name (Legal Business Name): FAMILY CARE CENTERS OF OKLAHOMA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 E CONNER
FAIRLAND OK
74343
US

IV. Provider business mailing address

PO BOX 72250
CORPUS CHRISTI TX
78472-2250
US

V. Phone/Fax

Practice location:
  • Phone: 918-676-3685
  • Fax: 918-676-3008
Mailing address:
  • Phone: 361-852-9521
  • Fax: 361-855-1454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License NumberNH5803-5803
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH5803-5803
License Number StateOK

VIII. Authorized Official

Name: MRS. SHARIE FOLMAR
Title or Position: PRESIDENT
Credential: LNFA
Phone: 361-852-9521