Organization
COAL COUNTY EXTENDED CARE INCORPORATED
Active
Other names
Ruth Wilson Hurley Manor
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TRENT A. BOURLAND (CHIEF EXECUTIVE OFFICER)
(580) 927-2327
Entity
Organization
Contact information
Practice address
7 N COVINGTON ST, COALGATE, OK 74538-2001
(580) 927-2000
(580) 927-9940
Mailing address
7 N COVINGTON ST, COALGATE, OK 74538-2001
(580) 927-2377
(580) 927-9940
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
NH1501-1501
OK
314000000X
Skilled Nursing Facility
NH1501-1501
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100774650A
—
OK
Enumeration date
07/18/2005
Last updated
07/07/2020
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