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General NPI Number Information
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NPI Number | 1679862718
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Entity Type | Organization
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Legal Business Name | WEWOKA NURSING HOME INC
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Dates
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Enumeration Date | 03/29/2011
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Last Update Date | 07/01/2011
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Provider Practice Location Address
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Address Line | 1400 W 1ST ST
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City | WEWOKA
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State | OK
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Zip | 74884-5006
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Country | US
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Telephone | 580-436-0950
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Fax | 580-436-0953
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Provider Business Mailing Address
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Address Line | 131 N BROADWAY AVE
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City | ADA
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State | OK
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Zip | 74820-5003
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Country | US
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Telephone | 580-436-0950
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Fax | 580-436-0953
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN SMART
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Credential |
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Telephone | 405-380-6902
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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 | NH6705-6705
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | NH6705-6705
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License Number State | OK
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