Provider Demographics
NPI:1144227950
Name:HASKELL COUNTY NURSING CENTER
Entity Type:Organization
Organization Name:HASKELL COUNTY NURSING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDMUND
Authorized Official - Middle Name:
Authorized Official - Last Name:STITES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-775-9161
Mailing Address - Street 1:1402 NW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:STIGLER
Mailing Address - State:OK
Mailing Address - Zip Code:74462-2791
Mailing Address - Country:US
Mailing Address - Phone:918-967-3381
Mailing Address - Fax:918-967-3382
Practice Address - Street 1:1402 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:STIGLER
Practice Address - State:OK
Practice Address - Zip Code:74462-2791
Practice Address - Country:US
Practice Address - Phone:918-967-3381
Practice Address - Fax:918-967-3382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH3102-3102314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100772360AMedicaid
OK37-5497Medicare ID - Type Unspecified