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NPI Code Detail

MEDICARE: PAWHUSKA NURSING HOME, LLC

MEDICARE: PAWHUSKA NURSING HOME, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1313M00000XNursing Facility/Intermediate Care FacilityNH5704-5704OK

General Provider Information

NPI Number : 1134220213
Entity Type Code : Organization
Provider Name (Legal Business Name) : PAWHUSKA NURSING HOME, LLC
Provider Business Mailing Address
First Line : PO BOX 429
Second Line :
City : SALLISAW
State : OK
Zip : 74955-0429
Country : US
Telephone Number : 918-775-4439
Fax Number : 918-775-9242
Provider Business Practice Location Address
First Line : 210 EAST CHOCTAW STREET
Second Line :
City : SALLISAW
State : OK
Zip : 74955-0429
Country : US
Telephone Number : 918-775-4439
Fax Number : 918-775-9242
Authorized Official
Title or Position : BUSINESS MANAGEMENT
Name : MR. JUSTIN MCGREW
Credential :
Telephone Number : 918-775-4439
Provider Enumeration Date : 09/25/2006
Last Update Date : 08/22/2020

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Directions to “PAWHUSKA NURSING HOME, LLC ” Practice Location

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