Organization
QUAIL RIDGE LIVING CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LINDA LEA CARTER (ADMINISTRATOR)
(918) 422-5139
Entity
Organization
Contact information
Practice address
564 STATE LINE RD, COLCORD, OK 74338
(918) 422-5139
(918) 422-9998
Mailing address
PO BOX 1005, SILOAM SPRINGS, AR 72761
(918) 422-5139
(918) 422-9998
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NH21052105
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000375175001
BLUE CROSS BLUE SHIELD
—
Enumeration date
09/16/2006
Last updated
08/22/2020
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