=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790718393
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CONTEMPORARY ENTERPRISES, LTD.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2006
-----------------------------------------------------
Last Update Date | 01/19/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 721 W OLIVE ST
-----------------------------------------------------
City | STROUD
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74079-4500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-968-2075
-----------------------------------------------------
Fax | 918-968-4498
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 680
-----------------------------------------------------
City | STROUD
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74079-0680
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-968-2075
-----------------------------------------------------
Fax | 918-968-4498
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. DEBBIE JO GARRETT
-----------------------------------------------------
Credential | RN, ADMINISTRATOR
-----------------------------------------------------
Telephone | 918-968-2075
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | NH4101-4101
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 313M00000X
-----------------------------------------------------
Taxonomy Name | Nursing Facility/Intermediate Care Facility
-----------------------------------------------------
License Number | NH4101-4101
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------