Provider Demographics
NPI:1497964639
Name:DOW RESIDENTIAL CARE FACILITY INC
Entity Type:Organization
Organization Name:DOW RESIDENTIAL CARE FACILITY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCBEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-297-2485
Mailing Address - Street 1:921 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:HARTSHORNE
Mailing Address - State:OK
Mailing Address - Zip Code:74547-3641
Mailing Address - Country:US
Mailing Address - Phone:918-297-2485
Mailing Address - Fax:918-297-2959
Practice Address - Street 1:1515 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:HARTSHORNE
Practice Address - State:OK
Practice Address - Zip Code:74547-3841
Practice Address - Country:US
Practice Address - Phone:918-297-2485
Practice Address - Fax:918-297-2959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKRC6102-6102310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility