MEDICARE: RECEIVER CARE 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
1	314000000X	Skilled Nursing Facility	NH5551	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568768000
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RECEIVER CARE LLC

Provider Business Mailing Address
First Line	:	119 N ROBINSON AVE STE 400
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73102-4613
Country	:	US
Telephone Number	:	405-272-0511
Fax Number	:	405-272-0501

Provider Business Practice Location Address
First Line	:	2400 WHITES MEADOW DR
Second Line	:
City	:	HARRAH
State	:	OK
Zip	:	73045-9402
Country	:	US
Telephone Number	:	405-454-6255
Fax Number	:

Authorized Official
Title or Position	:	RECEIVER
Name	:	MR. DAVID R. PAYNE
Credential	:
Telephone Number	:	405-272-0511

Provider Enumeration Date	:	02/01/2011
Last Update Date	:	05/13/2011

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Directions to “RECEIVER CARE LLC ” Practice Location

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