# COAL COUNTY EXTENDED CARE INCORPORATED

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Ruth Wilson Hurley Manor
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639178130
- **Authorized official:** MR. TRENT A. BOURLAND (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (580) 927-2327

## Contact information

- **Practice address:** 7 N COVINGTON ST, COALGATE, OK 74538-2001
- **Practice address phone:** (580) 927-2000
- **Practice address fax:** (580) 927-9940
- **Mailing address:** 7 N COVINGTON ST, COALGATE, OK 74538-2001
- **Mailing address phone:** (580) 927-2377
- **Mailing address fax:** (580) 927-9940

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | NH1501-1501 | OK | Yes |
| 314000000X | Skilled Nursing Facility | NH1501-1501 | OK | — |

## Other

- **Enumeration date:** 07/18/2005
- **Last updated:** 07/07/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100774650A | — | OK |