Organization
IHS WYNNEWOOD CARE CENTER LLC
Active
Other names
Wynnewood Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BART TAYLOR REED (PRESIDENT)
(580) 436-0950
Entity
Organization
Contact information
Practice address
131 N BROADWAY AVE, ADA, OK 74820-5003
(580) 436-0950
(580) 436-0953
Mailing address
810 E CALIFORNIA ST, WYNNEWOOD, OK 73098-3207
(405) 665-2330
(405) 943-4917
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
NH2506-2506
OK
314000000X
Skilled Nursing Facility
NH2506-2506
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007767770A
—
OK
Enumeration date
09/10/2007
Last updated
09/24/2007
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