Provider Demographics
NPI:1114590098
Name:MADILL OPERATING CO, LLC
Entity Type:Organization
Organization Name:MADILL OPERATING CO, LLC
Other - Org Name:BROOKSIDE NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:C
Authorized Official - Last Name:COBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-220-7093
Mailing Address - Street 1:1908 12TH AVE NW STE E
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-1255
Mailing Address - Country:US
Mailing Address - Phone:580-226-3055
Mailing Address - Fax:
Practice Address - Street 1:310 BROOKSIDE DR
Practice Address - Street 2:
Practice Address - City:MADILL
Practice Address - State:OK
Practice Address - Zip Code:73446-3638
Practice Address - Country:US
Practice Address - Phone:580-795-2100
Practice Address - Fax:580-677-9918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility