MEDICARE: KINGS DAUGHTERS & SONS NURSING HOME

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	313M00000X	Nursing Facility/Intermediate Care Facility	NH0705-0705	OK

General Provider Information

NPI Number	:	1689768749
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINGS DAUGHTERS & SONS NURSING HOME

Provider Business Mailing Address
First Line	:	1223 BALTIMORE ST
Second Line	:
City	:	DURANT
State	:	OK
Zip	:	74701-3243
Country	:	US
Telephone Number	:	580-924-0496
Fax Number	:	580-924-7724

Provider Business Practice Location Address
First Line	:	1223 BALTIMORE ST
Second Line	:
City	:	DURANT
State	:	OK
Zip	:	74701-3243
Country	:	US
Telephone Number	:	580-924-0496
Fax Number	:	580-924-7724

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. KIM M OWEN
Credential	:	ADMINISTRATOR
Telephone Number	:	580-924-0496

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	08/22/2020

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