# PAULS VALLEY CARE CENTER LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Pauls Valley Care Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1740412998
- **Authorized official:** BART REED (MANAGER)
- **Authorized official phone:** (580) 436-0950

## Contact information

- **Practice address:** 1413 S CHICKASAW ST, PAULS VALLEY, OK 73075-6415
- **Practice address phone:** (405) 238-6411
- **Mailing address:** 1413 S CHICKASAW ST, PAULS VALLEY, OK 73075-6415
- **Mailing address phone:** (405) 238-6411

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | NH2504-2504 | OK | — |
| 314000000X | Skilled Nursing Facility | NH2504-2504 | OK | Yes |

## Other

- **Enumeration date:** 08/20/2009
- **Last updated:** 04/07/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100778860A | — | OK |