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Organization
CORN HERITAGE VILLAGE OF CORN INC
Active
Organization
CORN HERITAGE VILLAGE OF CORN INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARTIN HALL (EXECUTIVE DIRECTOR)
(580) 343-2295
Entity
Organization
Contact information
Practice address
106 W ADAMS STREET, CORN, OK 73024
(580) 343-2295
(580) 343-2297
Mailing address
PO BOX 98, CORN, OK 73024-0098
(580) 343-2295
(580) 343-2297
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
NH7502-7502
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200265350A
—
OK
Enumeration date
06/30/2009
Last updated
12/09/2009
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