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General NPI Number Information
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NPI Number | 1316059645
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Entity Type | Organization
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Legal Business Name | WAYNOKA NURSING CENTER AUTHORITY
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 01/31/2012
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Provider Practice Location Address
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Address Line | 2601 BROADWAY ST
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City | WAYNOKA
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State | OK
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Zip | 73860-6812
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Country | US
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Telephone | 580-824-5661
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Fax | 580-824-5662
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Provider Business Mailing Address
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Address Line | 2601 BROADWAY ST
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City | WAYNOKA
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State | OK
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Zip | 73860-6812
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Country | US
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Telephone | 580-824-5661
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Fax | 580-824-5662
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | TOM LEATHERMAN
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Credential |
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Telephone | 580-824-5661
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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 | NH7603-7603
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License Number State | OK
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