Provider Demographics
NPI:1568768000
Name:RECEIVER CARE LLC
Entity Type:Organization
Organization Name:RECEIVER CARE LLC
Other - Org Name:HARRAH NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RECEIVER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-272-0511
Mailing Address - Street 1:119 N ROBINSON AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-4613
Mailing Address - Country:US
Mailing Address - Phone:405-272-0511
Mailing Address - Fax:405-272-0501
Practice Address - Street 1:2400 WHITES MEADOW DR
Practice Address - Street 2:
Practice Address - City:HARRAH
Practice Address - State:OK
Practice Address - Zip Code:73045-9402
Practice Address - Country:US
Practice Address - Phone:405-454-6255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-01
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH5551314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200317210CMedicaid