Provider Demographics
NPI:1821209537
Name:CRAIG COUNTY MEDICAL SERVICE CORPORATION
Entity Type:Organization
Organization Name:CRAIG COUNTY MEDICAL SERVICE CORPORATION
Other - Org Name:HEARTSWORTH HOUSE SENIOR LIVING COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HANEGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-744-3525
Mailing Address - Street 1:821 N FOREMAN ST
Mailing Address - Street 2:
Mailing Address - City:VINITA
Mailing Address - State:OK
Mailing Address - Zip Code:74301-1434
Mailing Address - Country:US
Mailing Address - Phone:918-256-7856
Mailing Address - Fax:
Practice Address - Street 1:821 N FOREMAN ST
Practice Address - Street 2:
Practice Address - City:VINITA
Practice Address - State:OK
Practice Address - Zip Code:74301-1434
Practice Address - Country:US
Practice Address - Phone:918-256-7856
Practice Address - Fax:918-256-7857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKAL1802310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility