MEDICARE: ADA CARE CENTER 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	NH6201-6201	OK
2	313M00000X	Nursing Facility/Intermediate Care Facility	NH6201-6201	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	:	1982836136
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADA CARE CENTER LLC

Provider Business Mailing Address
First Line	:	931 N COUNTRY CLUB RD
Second Line	:
City	:	ADA
State	:	OK
Zip	:	74820-2845
Country	:	US
Telephone Number	:	580-332-3631
Fax Number	:

Provider Business Practice Location Address
First Line	:	931 N COUNTRY CLUB RD
Second Line	:
City	:	ADA
State	:	OK
Zip	:	74820-2845
Country	:	US
Telephone Number	:	580-332-3631
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	BART REED
Credential	:
Telephone Number	:	580-436-0950

Provider Enumeration Date	:	08/20/2009
Last Update Date	:	04/07/2020

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Directions to “ADA CARE CENTER LLC ” Practice Location

Language	Start Address	Practice Location

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