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General NPI Number Information
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NPI Number | 1306809884
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Entity Type | Organization
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Legal Business Name | CORN HERITAGE VILLAGE OF WEATHERFORD INC
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Dates
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Enumeration Date | 04/07/2006
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Last Update Date | 06/01/2009
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Provider Practice Location Address
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Address Line | 801 N WASHINGTON ST
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City | WEATHERFORD
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State | OK
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Zip | 73096-4032
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Country | US
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Telephone | 580-772-3993
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Fax | 580-774-1032
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Provider Business Mailing Address
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Address Line | 801 N WASHINGTON ST
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City | WEATHERFORD
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State | OK
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Zip | 73096-4032
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Country | US
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Telephone | 580-772-3993
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Fax | 580-774-1032
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MARTIN HALL
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Credential |
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Telephone | 580-343-2295
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | NH2002
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License Number State | OK
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