Organization
CORDELL CHRISTIAN HOME INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ROBERTA GAIL WILCOX (ADMINISTRATOR)
(580) 832-3371
Entity
Organization
Contact information
Practice address
1400 N COLLEGE ST, CORDELL, OK 73632-1822
(580) 832-3371
(580) 832-2732
Mailing address
1400 N COLLEGE ST, CORDELL, OK 73632-1822
(580) 832-3371
(580) 832-2732
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NH7501-7501
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100773140 A
—
OK
Enumeration date
08/11/2006
Last updated
01/21/2021
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