Provider Demographics
NPI:1598743387
Name:HEARTWAY CORPORATION
Entity Type:Organization
Organization Name:HEARTWAY CORPORATION
Other - Org Name:MEMORIAL HEIGHTS NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:SUZETTE
Authorized Official - Last Name:BAUCOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-286-1065
Mailing Address - Street 1:1305 SE ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:IDABEL
Mailing Address - State:OK
Mailing Address - Zip Code:74745-5240
Mailing Address - Country:US
Mailing Address - Phone:580-286-1065
Mailing Address - Fax:580-286-3926
Practice Address - Street 1:1305 SE ADAMS ST
Practice Address - Street 2:
Practice Address - City:IDABEL
Practice Address - State:OK
Practice Address - Zip Code:74745
Practice Address - Country:US
Practice Address - Phone:580-286-3366
Practice Address - Fax:580-286-3022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-03
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH4504-4504314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100778790AMedicaid
37-5123Medicare Oscar/Certification