Provider Demographics
NPI:1790718393
Name:CONTEMPORARY ENTERPRISES, LTD.
Entity Type:Organization
Organization Name:CONTEMPORARY ENTERPRISES, LTD.
Other - Org Name:STROUD HEALTH CARE CENTER SOUTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:JO
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:RN, ADMINISTRATOR
Authorized Official - Phone:918-968-2075
Mailing Address - Street 1:PO BOX 680
Mailing Address - Street 2:
Mailing Address - City:STROUD
Mailing Address - State:OK
Mailing Address - Zip Code:74079-0680
Mailing Address - Country:US
Mailing Address - Phone:918-968-2075
Mailing Address - Fax:918-968-4498
Practice Address - Street 1:721 W OLIVE ST
Practice Address - Street 2:
Practice Address - City:STROUD
Practice Address - State:OK
Practice Address - Zip Code:74079-4500
Practice Address - Country:US
Practice Address - Phone:918-968-2075
Practice Address - Fax:918-968-4498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH4101-4101313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100771830AMedicaid
OK5055850001Medicare NSC
OK375367Medicare Oscar/Certification