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Organization
AWENASA MANAGEMENT LLC
Active
Organization
AWENASA MANAGEMENT LLC
Active
Other names
Family Care Center of Fairland
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TERESA MAHURIN (MANAGING MEMBER)
(918) 476-6642
Entity
Organization
Contact information
Practice address
12 E CONNER AVE., FAIRLAND, OK 74343-0336
(918) 676-3685
(918) 676-3008
Mailing address
5430 W 640, CHOUTEAU, OK 74337-5504
(918) 476-6642
(918) 476-4679
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
—
NULL
314000000X
Skilled Nursing Facility
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37-5515
MEDICARE CCN
—
05
—
37E258
—
OK
Enumeration date
12/08/2011
Last updated
12/14/2011
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