# WAYNOKA NURSING CENTER AUTHORITY

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

## Provider details

- **NPI number:** 1316059645
- **Authorized official:** TOM LEATHERMAN (ADMINISTRATOR)
- **Authorized official phone:** (580) 824-5661

## Contact information

- **Practice address:** 2601 BROADWAY ST, WAYNOKA, OK 73860-6812
- **Practice address phone:** (580) 824-5661
- **Practice address fax:** (580) 824-5662
- **Mailing address:** 2601 BROADWAY ST, WAYNOKA, OK 73860-6812
- **Mailing address phone:** (580) 824-5661
- **Mailing address fax:** (580) 824-5662

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | NH7603-7603 | OK | Yes |

## Other

- **Enumeration date:** 08/31/2006
- **Last updated:** 01/31/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100777950A | — | OK |