Healthcare Provider Details

I. General information

NPI: 1922219716
Provider Name (Legal Business Name): STILWELL NURSING HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 11/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 W LOCUST ST
STILWELL OK
74960-3644
US

IV. Provider business mailing address

PO BOX 1095
GUTHRIE OK
73044-1095
US

V. Phone/Fax

Practice location:
  • Phone: 918-696-7715
  • Fax: 918-696-4638
Mailing address:
  • Phone: 405-282-6285
  • Fax: 405-282-5731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH0101
License Number StateOK

VIII. Authorized Official

Name: TANDIE HASTINGS
Title or Position: MANAGING MEMBER
Credential:
Phone: 405-282-6285