Organization
BROKEN ARROW NURSING HOME INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JOANNA MAE COOPER (OWNER OPERATOR)
(918) 251-5343
Entity
Organization
Contact information
Practice address
424 N DATE AVE, BROKEN ARROW, OK 74012-3872
(918) 251-5343
(918) 258-9942
Mailing address
424 N DATE AVE, BROKEN ARROW, OK 74012-3872
(918) 251-5343
(918) 258-9942
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
7205
OK
314000000X
Skilled Nursing Facility
Primary
7205
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100772960A
—
OK
Enumeration date
03/22/2007
Last updated
03/11/2016
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