Provider Demographics
NPI:1023005113
Name:CHOCTAW NATION CARE CENTER LLC
Entity Type:Organization
Organization Name:CHOCTAW NATION CARE CENTER LLC
Other - Org Name:CHOCTAW NATION CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:BRANDON
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-235-6443
Mailing Address - Street 1:400 SW O ST
Mailing Address - Street 2:
Mailing Address - City:ANTLERS
Mailing Address - State:OK
Mailing Address - Zip Code:74523-3416
Mailing Address - Country:US
Mailing Address - Phone:580-298-5528
Mailing Address - Fax:580-298-6316
Practice Address - Street 1:400 SW O ST
Practice Address - Street 2:
Practice Address - City:ANTLERS
Practice Address - State:OK
Practice Address - Zip Code:74523-3416
Practice Address - Country:US
Practice Address - Phone:580-298-5528
Practice Address - Fax:580-298-2755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100699600AMedicaid
OK100699600AMedicaid