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Organization

WAYNOKA NURSING CENTER AUTHORITY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
TOM LEATHERMAN (ADMINISTRATOR)
(580) 824-5661
Entity
Organization

Contact information

Practice address
2601 BROADWAY ST, WAYNOKA, OK 73860-6812
(580) 824-5661
(580) 824-5662
Mailing address
2601 BROADWAY ST, WAYNOKA, OK 73860-6812
(580) 824-5661
(580) 824-5662

Taxonomy

Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
NH7603-7603
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100777950A
OK
Enumeration date
08/31/2006
Last updated
01/31/2012
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