Provider Demographics
NPI:1598856288
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 KINGSTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER/TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DRENDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:918-397-0007
Mailing Address - Street 1:HC 71 BOX 83
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:OK
Mailing Address - Zip Code:73439-9701
Mailing Address - Country:US
Mailing Address - Phone:580-546-2216
Mailing Address - Fax:580-564-2298
Practice Address - Street 1:701 HWY 32
Practice Address - Street 2:HC 71
Practice Address - City:KINGSTON
Practice Address - State:OK
Practice Address - Zip Code:73439-9701
Practice Address - Country:US
Practice Address - Phone:580-564-2216
Practice Address - Fax:580-564-2298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH58035803314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100847060AMedicaid
OK375437Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER