Organization
GO YE VILLAGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES A RICHARDSON (EXECUTIVE DIRECTOR)
(918) 456-4542
Entity
Organization
Contact information
Practice address
1201 W 4TH ST, TAHLEQUAH, OK 74464-5091
(918) 456-4542
(918) 458-5492
Mailing address
1201 W 4TH ST, TAHLEQUAH, OK 74464-5091
(918) 456-4542
(918) 458-5492
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
NH1102
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NH1102
NURSING FACILITY
OK
Enumeration date
05/24/2007
Last updated
08/22/2020
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