Healthcare Provider Details

I. General information

NPI: 1639166085
Provider Name (Legal Business Name): HARMON COUNTY HEALTHCARE TRUST AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W VERSA ST
HOLLIS OK
73550-3046
US

IV. Provider business mailing address

PO BOX 793
HOLLIS OK
73550-0793
US

V. Phone/Fax

Practice location:
  • Phone: 580-688-9431
  • Fax: 580-688-2491
Mailing address:
  • Phone: 580-688-9431
  • Fax: 580-688-2491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License NumberNH2902-2902
License Number StateOK

VIII. Authorized Official

Name: MS. HOPE SMITH
Title or Position: ADMINISTRATOR
Credential:
Phone: 580-688-9431