| NPI | 1194843169 |
|---|---|
| Doing Business As | COUNTRY LANE COTTAGE #1 |
| Entity Type | Organization |
| Authorized Contact | SCOTT PLIGRIM Managing Member 405-285-8166 |
| Organization Subpart ? | No |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Intellectual Disabilities (Licence: OK NH5615) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2008-07-15 |