Organization
CORN HERITAGE VILLAGE OF CORN INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARTIN HALL (EXECUTIVE DIRECTOR)
(580) 343-2295
Entity
Organization
Contact information
Practice address
106 W ADAMS STREET, CORN, OK 73024
(580) 343-2295
(580) 343-2297
Mailing address
PO BOX 98, CORN, OK 73024-0098
(580) 343-2295
(580) 343-2297
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
NH7502-7502
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200265350A
—
OK
Enumeration date
06/30/2009
Last updated
12/09/2009
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