# KANAKUK, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** COUNTRY CLUB CARE
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316030414
- **Authorized official:** JOE LYNN GREGSTON (ADMINISTRATOR)
- **Authorized official phone:** (580) 255-4600

## Contact information

- **Practice address:** 1904 N HIGHWAY 81, DUNCAN, OK 73533-1447
- **Practice address phone:** (580) 255-4600
- **Practice address fax:** (580) 255-0438
- **Mailing address:** 1904 N HIGHWAY 81, DUNCAN, OK 73533-1447
- **Mailing address phone:** (580) 255-4600
- **Mailing address fax:** (580) 255-0438

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | NH69046904 | OK | Yes |

## Other

- **Enumeration date:** 10/02/2006
- **Last updated:** 08/20/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100773460 A | — | OK |
| 05 | — | 100773460A | — | OK |