Provider Demographics
NPI:1497872717
Name:FAMILY CARE CENTERS OF OKLAHOMA, LLC
Entity Type:Organization
Organization Name:FAMILY CARE CENTERS OF OKLAHOMA, LLC
Other - Org Name:FAMILY CARE CENTER OF FAIRLAND, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FOLMAR
Authorized Official - Suffix:
Authorized Official - Credentials:LNFA
Authorized Official - Phone:361-852-9521
Mailing Address - Street 1:PO BOX 72250
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78472-2250
Mailing Address - Country:US
Mailing Address - Phone:361-852-9521
Mailing Address - Fax:361-855-1454
Practice Address - Street 1:12 E CONNER
Practice Address - Street 2:
Practice Address - City:FAIRLAND
Practice Address - State:OK
Practice Address - Zip Code:74343
Practice Address - Country:US
Practice Address - Phone:918-676-3685
Practice Address - Fax:918-676-3008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH5803-5803313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK37E258Medicaid
37-5515OtherMEDICARE CCN