Healthcare Provider Details

I. General information

NPI: 1346247285
Provider Name (Legal Business Name): QUINTON ELDER CARE HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 WEST MAIN
QUINTON OK
74561-0359
US

IV. Provider business mailing address

PO BOX 359
QUINTON OK
74561-0359
US

V. Phone/Fax

Practice location:
  • Phone: 918-469-2600
  • Fax: 918-469-2208
Mailing address:
  • Phone: 918-469-2600
  • Fax: 918-469-2208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. MARTHA KUYKENDALL
Title or Position: PRESIDENT
Credential:
Phone: 479-649-6170