Healthcare Provider Details

I. General information

NPI: 1326347519
Provider Name (Legal Business Name): RECEIVER CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2011
Last Update Date: 05/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 S 8TH ST
MCLOUD OK
74851-8500
US

IV. Provider business mailing address

119 N ROBINSON AVE STE 400
OKLAHOMA CITY OK
73102-4613
US

V. Phone/Fax

Practice location:
  • Phone: 405-964-2961
  • Fax: 405-964-2964
Mailing address:
  • Phone: 405-272-0511
  • Fax: 405-272-0501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH6309
License Number StateOK

VIII. Authorized Official

Name: MR. DAVID R. PAYNE
Title or Position: RECEIVER
Credential:
Phone: 405-272-0511