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General NPI Number Information
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NPI Number | 1922101088
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Entity Type | Organization
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Legal Business Name | MEDI-HOME OF ARKOMA INC
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Dates
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Enumeration Date | 09/06/2006
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Last Update Date | 08/27/2007
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Provider Practice Location Address
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Address Line | 1008 ARKANSAS STREET
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City | ARKOMA
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State | OK
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Zip | 74901-0410
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Country | US
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Telephone | 918-875-3107
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Fax | 918-875-3021
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Provider Business Mailing Address
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Address Line | PO BOX 410
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City | ARKOMA
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State | OK
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Zip | 74901-0410
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Country | US
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Telephone | 918-875-3107
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Fax | 918-875-3021
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ROY RALPH NICHOLS
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Credential |
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Telephone | 918-875-3107
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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 | NH4003-4003
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License Number State | OK
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