Provider Demographics
NPI:1417954900
Name:IHS STONEGATE NURSING CENTER INC
Entity Type:Organization
Organization Name:IHS STONEGATE NURSING CENTER INC
Other - Org Name:STONEGATE NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BART
Authorized Official - Middle Name:T
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-436-0950
Mailing Address - Street 1:130 E 6TH STREET
Mailing Address - Street 2:
Mailing Address - City:STONEWALL
Mailing Address - State:OK
Mailing Address - Zip Code:74871-0277
Mailing Address - Country:US
Mailing Address - Phone:580-436-0950
Mailing Address - Fax:580-436-0950
Practice Address - Street 1:130 E 6TH STREET
Practice Address - Street 2:
Practice Address - City:STONEWALL
Practice Address - State:OK
Practice Address - Zip Code:74871-0277
Practice Address - Country:US
Practice Address - Phone:580-436-0950
Practice Address - Fax:580-436-0950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH6205-6205314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100777760AMedicaid
OK100777760AMedicaid