# INDIAN TERRITORY LONG TERM CARE, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Indian Territory Provider Care Plus
- **Organization subpart:** No

## Provider details

- **NPI number:** 1457481426
- **Authorized official:** MR. JAYSON EARL NORTHCUTT (CHIEF OPERATIONS OFFICER)
- **Authorized official phone:** (580) 371-2106

## Contact information

- **Practice address:** 105 N NESHOBA ST, TISHOMINGO, OK 73460-1739
- **Practice address phone:** (580) 371-0015
- **Practice address fax:** (580) 371-3204
- **Mailing address:** 105 N NESHOBA ST, TISHOMINGO, OK 73460-1739
- **Mailing address phone:** (580) 371-0015
- **Mailing address fax:** (580) 371-3204

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251K00000X | Public Health or Welfare Agency | 100627980B | OK | Yes |

## Other

- **Enumeration date:** 03/07/2007
- **Last updated:** 11/20/2008