Organization
ARTESIAN HOME, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TOM C COBLE (OWNER)
(580) 226-3055
Entity
Organization
Contact information
Practice address
1415 W 15TH ST, SULPHUR, OK 73086-2003
(580) 622-2030
(580) 622-5752
Mailing address
1415 W 15TH ST, SULPHUR, OK 73086-2003
(580) 622-2030
(580) 622-5752
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
NH5001-5001
OK
314000000X
Skilled Nursing Facility
Primary
NH5001-5001
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100770850 A
—
OK
Enumeration date
07/20/2005
Last updated
07/30/2023
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