Provider Demographics
NPI:1437301512
Name:PROMISE MCLOUD LLC
Entity Type:Organization
Organization Name:PROMISE MCLOUD LLC
Other - Org Name:MCLOUD NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-573-7908
Mailing Address - Street 1:701 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MCLOUD
Mailing Address - State:OK
Mailing Address - Zip Code:74851-8500
Mailing Address - Country:US
Mailing Address - Phone:405-964-2962
Mailing Address - Fax:
Practice Address - Street 1:701 S 8TH ST
Practice Address - Street 2:
Practice Address - City:MCLOUD
Practice Address - State:OK
Practice Address - Zip Code:74851-8500
Practice Address - Country:US
Practice Address - Phone:405-964-2962
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH6309-6309314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK375347Medicare Oscar/Certification
OK37 5347Medicare PIN