# WAGONER CARE CENTER LLC

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

## Provider details

- **NPI number:** 1225094766
- **Authorized official:** MR. WILLIAM ALLEN HAYNES JR. LPN (MDS/CPC)
- **Authorized official phone:** (918) 485-2203

## Contact information

- **Practice address:** 205 N LINCOLN AVE, WAGONER, OK 74467-3915
- **Practice address phone:** (918) 485-2203
- **Practice address fax:** (918) 485-6673
- **Mailing address:** 205 N LINCOLN AVE, WAGONER, OK 74467-3915
- **Mailing address phone:** (918) 485-2203
- **Mailing address fax:** (918) 485-6673

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | NH7302-7302 | OK | Yes |

## Other

- **Enumeration date:** 04/24/2006
- **Last updated:** 08/22/2020