# ARTESIAN HOME, INC.

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

## Provider details

- **NPI number:** 1588663520
- **Authorized official:** TOM C COBLE (OWNER)
- **Authorized official phone:** (580) 226-3055

## Contact information

- **Practice address:** 1415 W 15TH ST, SULPHUR, OK 73086-2003
- **Practice address phone:** (580) 622-2030
- **Practice address fax:** (580) 622-5752
- **Mailing address:** 1415 W 15TH ST, SULPHUR, OK 73086-2003
- **Mailing address phone:** (580) 622-2030
- **Mailing address fax:** (580) 622-5752

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | NH5001-5001 | OK | — |
| 314000000X | Skilled Nursing Facility | NH5001-5001 | OK | Yes |

## Other

- **Enumeration date:** 07/20/2005
- **Last updated:** 07/30/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100770850 A | — | OK |