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Organization
IHS WYNNEWOOD CARE CENTER LLC
Active
Organization
IHS WYNNEWOOD CARE CENTER LLC
Active
Other names
Wynnewood Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BART TAYLOR REED (PRESIDENT)
(580) 436-0950
Entity
Organization
Contact information
Practice address
131 N BROADWAY AVE, ADA, OK 74820-5003
(580) 436-0950
(580) 436-0953
Mailing address
810 E CALIFORNIA ST, WYNNEWOOD, OK 73098-3207
(405) 665-2330
(405) 943-4917
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
NH2506-2506
OK
314000000X
Skilled Nursing Facility
NH2506-2506
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007767770A
—
OK
Enumeration date
09/10/2007
Last updated
09/24/2007
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