Healthcare Provider Details

I. General information

NPI: 1366654147
Provider Name (Legal Business Name): HARMON COUNTY HEALTHCARE AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E SYCAMORE ST
HOLLIS OK
73550-1436
US

IV. Provider business mailing address

PO BOX 793
HOLLIS OK
73550-0793
US

V. Phone/Fax

Practice location:
  • Phone: 580-688-9114
  • Fax: 580-688-2955
Mailing address:
  • Phone: 580-688-9114
  • Fax: 580-688-2955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License NumberNH2901
License Number StateOK

VIII. Authorized Official

Name: MR. CALVIN CASTLEMAN
Title or Position: CHAIRMAN OF THE BOARD
Credential:
Phone: 580-688-3531