Organization
AWENASA MANAGEMENT LLC
Active
Other names
Family Care Center of Fairland
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TERESA MAHURIN (MANAGING MEMBER)
(918) 476-6642
Entity
Organization
Contact information
Practice address
12 E CONNER AVE., FAIRLAND, OK 74343-0336
(918) 676-3685
(918) 676-3008
Mailing address
5430 W 640, CHOUTEAU, OK 74337-5504
(918) 476-6642
(918) 476-4679
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
—
—
314000000X
Skilled Nursing Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37-5515
MEDICARE CCN
—
05
—
37E258
—
OK
Enumeration date
12/08/2011
Last updated
12/14/2011
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