Organization
WAGONER CARE CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM ALLEN HAYNES JR. LPN (MDS/CPC)
(918) 485-2203
Entity
Organization
Contact information
Practice address
205 N LINCOLN AVE, WAGONER, OK 74467-3915
(918) 485-2203
(918) 485-6673
Mailing address
205 N LINCOLN AVE, WAGONER, OK 74467-3915
(918) 485-2203
(918) 485-6673
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
NH7302-7302
OK
Other
Enumeration date
04/24/2006
Last updated
08/22/2020
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