# SKIATOOK NURSING HOME, LLC

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

## Provider details

- **NPI number:** 1336247873
- **Authorized official:** MR. JUSTIN W. MCGREW (BUSINESS MANAGEMENT)
- **Authorized official phone:** (918) 775-4439

## Contact information

- **Practice address:** 318 S CHERRY ST, SKIATOOK, OK 74070-1325
- **Practice address phone:** (918) 396-2149
- **Practice address fax:** (918) 396-4256
- **Mailing address:** 318 S CHERRY ST, SKIATOOK, OK 74070-1325
- **Mailing address phone:** (918) 396-2149
- **Mailing address fax:** (918) 396-4256

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | NH5705-5705 | OK | Yes |

## Other

- **Enumeration date:** 09/20/2006
- **Last updated:** 08/08/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200078980A | — | OK |