# TIDWELL HEALTHCARE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Tidwell Living Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023430741
- **Authorized official:** MELISSA C TIDWELL RN, MHA (OWNER)
- **Authorized official phone:** (918) 465-5020

## Contact information

- **Practice address:** 900 RANCHWOOD DR, WILBURTON, OK 74578-3630
- **Practice address phone:** (918) 465-5020
- **Practice address fax:** (918) 465-5007
- **Mailing address:** 900 RANCHWOOD DR, WILBURTON, OK 74578-3630
- **Mailing address phone:** (918) 465-5020
- **Mailing address fax:** (918) 465-5007

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | NH3903-3903 | OK | Yes |

## Other

- **Enumeration date:** 01/15/2014
- **Last updated:** 12/31/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200522320A | — | OK |