# CORN HERITAGE VILAGE OF WEATHERFORD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023241494
- **Authorized official:** MARTIN HALL (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (580) 772-3993

## Contact information

- **Practice address:** 801 N WASHINGTON ST, WEATHERFORD, OK 73096-4032
- **Practice address phone:** (580) 772-3993
- **Practice address fax:** (580) 772-1032
- **Mailing address:** 801 N WASHINGTON ST, WEATHERFORD, OK 73096-4032
- **Mailing address phone:** (580) 772-3993
- **Mailing address fax:** (580) 772-1032

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | NH2002-2002 | OK | Yes |

## Other

- **Enumeration date:** 09/01/2009
- **Last updated:** 09/01/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200076200A | — | OK |