Healthcare Provider Details

I. General information

NPI: 1417048273
Provider Name (Legal Business Name): COLE BROS. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 E LUCILLE AVE
FREDERICK OK
73542-1427
US

IV. Provider business mailing address

313 E LUCILLE AVE
FREDERICK OK
73542-1427
US

V. Phone/Fax

Practice location:
  • Phone: 580-335-5591
  • Fax: 580-335-5323
Mailing address:
  • Phone: 580-335-5591
  • Fax: 580-335-5323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH71027102
License Number StateOK

VIII. Authorized Official

Name: MS. HELEN ANN REDEKER
Title or Position: CEO-MANAGER
Credential:
Phone: 580-335-3016