| NPI | 1891784070 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEWEY DEWAYNE PEBWORTH Administrator 580-286-2537 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: OK nh4505-4505) |
| Additional Taxonomies | 313M00000X Nursing Facility/Intermediate Care Facility (Licence: OK NH4505-4505) |
| Enumeration Date | 2005-10-19 |
| Last Update Date | 2008-02-25 |