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General NPI Number Information
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NPI Number | 1417048273
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Entity Type | Organization
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Legal Business Name | COLE BROS. INC.
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 313 E LUCILLE AVE
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City | FREDERICK
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State | OK
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Zip | 73542-1427
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Country | US
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Telephone | 580-335-5591
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Fax | 580-335-5323
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Provider Business Mailing Address
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Address Line | 313 E LUCILLE AVE
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City | FREDERICK
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State | OK
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Zip | 73542-1427
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Country | US
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Telephone | 580-335-5591
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Fax | 580-335-5323
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Authorized Official
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Title or Position | CEO-MANAGER
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Name | MS. HELEN ANN REDEKER
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Credential |
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Telephone | 580-335-3016
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | NH71027102
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License Number State | OK
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