Provider Demographics
NPI:1841577905
Name:SPANISH COVE HOUSING AUTHORITY
Entity Type:Organization
Organization Name:SPANISH COVE HOUSING AUTHORITY
Other - Org Name:SPANISH COVE RETIREMENT VILLAGE
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE ADMINISTRATOR/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SHERMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-350-5000
Mailing Address - Street 1:11 PALM AVE
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-5645
Mailing Address - Country:US
Mailing Address - Phone:405-354-1901
Mailing Address - Fax:
Practice Address - Street 1:11 PALM AVE
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-5645
Practice Address - Country:US
Practice Address - Phone:405-354-1901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKCC09010901311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home