# CORN HERITAGE VILLAGE OF CORN INC

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

## Provider details

- **NPI number:** 1396973210
- **Authorized official:** MR. MARTIN HALL (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (580) 343-2295

## Contact information

- **Practice address:** 106 W ADAMS STREET, CORN, OK 73024
- **Practice address phone:** (580) 343-2295
- **Practice address fax:** (580) 343-2297
- **Mailing address:** PO BOX 98, CORN, OK 73024-0098
- **Mailing address phone:** (580) 343-2295
- **Mailing address fax:** (580) 343-2297

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | NH7502-7502 | OK | Yes |

## Other

- **Enumeration date:** 06/30/2009
- **Last updated:** 12/09/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200265350A | — | OK |