Healthcare Provider Details

I. General information

NPI: 1598856288
Provider Name (Legal Business Name): FAMILY CARE CENTERS OF OKLAHOMA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 06/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 HWY 32 HC 71
KINGSTON OK
73439-9701
US

IV. Provider business mailing address

HC 71 BOX 83
KINGSTON OK
73439-9701
US

V. Phone/Fax

Practice location:
  • Phone: 580-564-2216
  • Fax: 580-564-2298
Mailing address:
  • Phone: 580-546-2216
  • Fax: 580-564-2298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH58035803
License Number StateOK

VIII. Authorized Official

Name: MRS. DRENDA L. COX
Title or Position: MANAGING PARTNER/TREASURER
Credential: RN
Phone: 918-397-0007