Organization
MEADOW BROOK ICF/MR #2
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TABITHA BUNDY (ADMINISTRATOR)
(918) 658-3656
Entity
Organization
Contact information
Practice address
1500 MEADOW LANE, HOWE, OK 74940
(918) 658-3656
(918) 658-3967
Mailing address
1500 MEADOW LANE, HOWE, OK 74940
(918) 658-3656
(918) 658-3967
Taxonomy
Speciality
Code
Description
License number
State
310500000X
Mental Illness Intermediate Care Facility
Primary
NH4004-4004
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NH4004-4004
OKLAHOMA STATE DEPARTMENT OF HEALTH
OK
Enumeration date
07/02/2008
Last updated
07/02/2008
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