| NPI | 1376075051 |
|---|---|
| Doing Business As | COUNTRY LANE COTTAGE 5 |
| Entity Type | Organization |
| Authorized Contact | SCOTT PILGRIM Member 405-285-8166 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: OK NH5619) |
| Enumeration Date | 2017-03-31 |
| Last Update Date | 2017-03-31 |