Healthcare Provider Details

I. General information

NPI: 1417954900
Provider Name (Legal Business Name): IHS STONEGATE NURSING CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 12/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 E 6TH STREET
STONEWALL OK
74871-0277
US

IV. Provider business mailing address

130 E 6TH STREET
STONEWALL OK
74871-0277
US

V. Phone/Fax

Practice location:
  • Phone: 580-436-0950
  • Fax: 580-436-0950
Mailing address:
  • Phone: 580-436-0950
  • Fax: 580-436-0950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH6205-6205
License Number StateOK

VIII. Authorized Official

Name: MR. BART T REED
Title or Position: PRESIDENT
Credential:
Phone: 580-436-0950