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General NPI Number Information
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NPI Number | 1881721637
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Entity Type | Organization
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Legal Business Name | POCOLA NURSING CENTER LLC
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 01/23/2012
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Provider Practice Location Address
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Address Line | 200 HOME STREET
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City | POCOLA
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State | OK
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Zip | 74902
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Country | US
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Telephone | 918-436-2228
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 869
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City | POCOLA
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State | OK
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Zip | 74902-0869
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | CHRIS HENSLEY
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Credential |
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Telephone | 918-436-2228
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3140N1450X
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Taxonomy Name | Pediatric Skilled Nursing Facility
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License Number | 100777480A
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License Number State | OK
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