Provider Demographics
NPI:1710980552
Name:BARTLESVILLE CARE CENTER INC.
Entity Type:Organization
Organization Name:BARTLESVILLE CARE CENTER INC.
Other - Org Name:BARTLESVILLE HEALTH & REHAB COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:DOUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-333-9545
Mailing Address - Street 1:3434 KENTUCKY PL
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-2339
Mailing Address - Country:US
Mailing Address - Phone:918-333-9545
Mailing Address - Fax:918-333-9601
Practice Address - Street 1:3434 KENTUCKY PL
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-2339
Practice Address - Country:US
Practice Address - Phone:918-333-9545
Practice Address - Fax:918-333-9601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH7403-7403314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100777490AMedicaid
OK37-5110Medicare PIN