Provider Demographics
NPI:1053311704
Name:CONTINUOUS CARE CENTER OF BARTLESVILLE INC
Entity Type:Organization
Organization Name:CONTINUOUS CARE CENTER OF BARTLESVILLE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:BASIL
Authorized Official - Middle Name:
Authorized Official - Last Name:WYATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-749-8930
Mailing Address - Street 1:1924 S UTICA AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-6510
Mailing Address - Country:US
Mailing Address - Phone:918-749-8930
Mailing Address - Fax:918-749-9373
Practice Address - Street 1:3500 EAST FRANK PHILLIPS BLVD
Practice Address - Street 2:TOWER 4
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-2411
Practice Address - Country:US
Practice Address - Phone:918-749-8930
Practice Address - Fax:918-749-9373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-22
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2357282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200030240AMedicaid
OK372014Medicare Oscar/Certification