Organization
CORN HERITAGE VILLAGE OF WEATHERFORD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARTIN HALL (EXECUTIVE DIRECTOR)
(580) 343-2295
Entity
Organization
Contact information
Practice address
801 N WASHINGTON ST, WEATHERFORD, OK 73096-4032
(580) 772-3993
(580) 774-1032
Mailing address
801 N WASHINGTON ST, WEATHERFORD, OK 73096-4032
(580) 772-3993
(580) 774-1032
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
NH2002
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200076200A
—
OK
Enumeration date
04/07/2006
Last updated
06/01/2009
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