Provider Demographics
NPI:1306198932
Name:FCC OF KINGSTON LLC
Entity Type:Organization
Organization Name:FCC OF KINGSTON LLC
Other - Org Name:FAMILY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCEARCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-905-9133
Mailing Address - Street 1:701 HIGHWAY 32
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:OK
Mailing Address - Zip Code:73439-8073
Mailing Address - Country:US
Mailing Address - Phone:580-564-2216
Mailing Address - Fax:580-564-2298
Practice Address - Street 1:701 HIGHWAY 32
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:OK
Practice Address - Zip Code:73439-8073
Practice Address - Country:US
Practice Address - Phone:580-564-2216
Practice Address - Fax:580-564-2298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH4802-4802314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKNH-4802-4802OtherNURSING HOME ID