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Organization
KANAKUK, INC.
Active
Organization
KANAKUK, INC.
Active
Other names
COUNTRY CLUB CARE
Organization subpart
No
Provider details
NPI number
Authorized official
JOE LYNN GREGSTON (ADMINISTRATOR)
(580) 255-4600
Entity
Organization
Contact information
Practice address
1904 N HIGHWAY 81, DUNCAN, OK 73533-1447
(580) 255-4600
(580) 255-0438
Mailing address
1904 N HIGHWAY 81, DUNCAN, OK 73533-1447
(580) 255-4600
(580) 255-0438
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NH69046904
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100773460 A
—
OK
05
—
100773460A
—
OK
Enumeration date
10/02/2006
Last updated
08/20/2009
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