Organization
WAGONER CARE CENTER LLC
Active
Other names
Wagoner Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTIN PRICE (MEMBER)
(918) 967-9285
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
314000000X
Skilled Nursing Facility
Primary
100771420A
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100771420A
—
OK
Enumeration date
02/07/2007
Last updated
01/20/2012
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