Organization
SKIATOOK NURSING HOME, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JUSTIN W. MCGREW (BUSINESS MANAGEMENT)
(918) 775-4439
Entity
Organization
Contact information
Practice address
318 S CHERRY ST, SKIATOOK, OK 74070-1325
(918) 396-2149
(918) 396-4256
Mailing address
318 S CHERRY ST, SKIATOOK, OK 74070-1325
(918) 396-2149
(918) 396-4256
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
NH5705-5705
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200078980A
—
OK
Enumeration date
09/20/2006
Last updated
08/08/2012
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