Provider Demographics
NPI:1689768749
Name:KINGS DAUGHTERS & SONS NURSING HOME
Entity Type:Organization
Organization Name:KINGS DAUGHTERS & SONS NURSING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:M
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:580-924-0496
Mailing Address - Street 1:1223 BALTIMORE ST
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-3243
Mailing Address - Country:US
Mailing Address - Phone:580-924-0496
Mailing Address - Fax:580-924-7724
Practice Address - Street 1:1223 BALTIMORE ST
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-3243
Practice Address - Country:US
Practice Address - Phone:580-924-0496
Practice Address - Fax:580-924-7724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH0705-0705313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK375397Medicare ID - Type Unspecified