=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376542902
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARE NURSING HOME INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/15/2005
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6308 NBU
-----------------------------------------------------
City | PRAGUE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74864-2523
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-567-2201
-----------------------------------------------------
Fax | 405-567-2395
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 W. PARKLAND AVE.
-----------------------------------------------------
City | PRAGUE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74864-9615
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-567-2201
-----------------------------------------------------
Fax | 405-567-2395
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SECRETARY/TREASURER
-----------------------------------------------------
Name | MS. PATRICIA CONNERY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 405-567-2201
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | NH4103-4103
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------