Provider Demographics
NPI:1316038037
Name:UNITED METHODIST HOME OF ENID, INC
Entity Type:Organization
Organization Name:UNITED METHODIST HOME OF ENID, INC
Other - Org Name:THE COMMONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LADEANA
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:BURRELL
Authorized Official - Suffix:
Authorized Official - Credentials:NFA
Authorized Official - Phone:580-237-6164
Mailing Address - Street 1:301 S OAKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-4918
Mailing Address - Country:US
Mailing Address - Phone:580-237-6164
Mailing Address - Fax:580-237-6178
Practice Address - Street 1:301 S OAKWOOD RD
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-4918
Practice Address - Country:US
Practice Address - Phone:580-237-6164
Practice Address - Fax:580-237-6178
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNITED METHODIST HOME OF ENID, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-27
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKCC2401310400000X, 311500000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100773220AMedicaid