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General NPI Number Information
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NPI Number | 1497964639
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Entity Type | Organization
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Legal Business Name | DOW RESIDENTIAL CARE FACILITY INC
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1515 PENNSYLVANIA AVE
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City | HARTSHORNE
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State | OK
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Zip | 74547-3841
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Country | US
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Telephone | 918-297-2485
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Fax | 918-297-2959
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Provider Business Mailing Address
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Address Line | 921 PENNSYLVANIA AVE
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City | HARTSHORNE
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State | OK
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Zip | 74547-3641
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Country | US
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Telephone | 918-297-2485
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Fax | 918-297-2959
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Authorized Official
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Title or Position | PRESIDENT-DIRECTOR
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Name | MRS. SHIRLEY MCBEE
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Credential |
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Telephone | 918-297-2485
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | RC6102-6102
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License Number State | OK
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