Organization
MEADOW BROOK ICFMR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TABITHA SUE BUNDY (ADMINISTRATOR)
(918) 658-3656
Entity
Organization
Contact information
Practice address
1200 MEADOW LANE, HOWE, OK 74940
(918) 658-3656
(918) 658-3967
Mailing address
1200 MEADOW LANE, HOWE, OK 74940
(918) 658-3656
(918) 658-3967
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37G117
STATE PROVIDER NUMBER
OK
Enumeration date
12/11/2006
Last updated
08/22/2020
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