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Organization
INDIAN TERRITORY LONG TERM CARE, INC.
Active
Organization
INDIAN TERRITORY LONG TERM CARE, INC.
Active
Other names
Indian Territory Provider Care Plus
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAYSON EARL NORTHCUTT (CHIEF OPERATIONS OFFICER)
(580) 371-2106
Entity
Organization
Contact information
Practice address
105 N NESHOBA ST, TISHOMINGO, OK 73460-1739
(580) 371-0015
(580) 371-3204
Mailing address
105 N NESHOBA ST, TISHOMINGO, OK 73460-1739
(580) 371-0015
(580) 371-3204
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
100627980B
OK
Other
Enumeration date
03/07/2007
Last updated
11/20/2008
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