Provider Demographics
NPI:1851562136
Name:THOMAS HEALTH AND REHABILITATION LLC
Entity Type:Organization
Organization Name:THOMAS HEALTH AND REHABILITATION LLC
Other - Org Name:THOMAS NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:S
Authorized Official - Last Name:EZELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-286-2537
Mailing Address - Street 1:601 EAST FRISCO STREET
Mailing Address - Street 2:
Mailing Address - City:THOMAS
Mailing Address - State:OK
Mailing Address - Zip Code:73669
Mailing Address - Country:US
Mailing Address - Phone:580-661-3260
Mailing Address - Fax:580-661-3263
Practice Address - Street 1:601 EAST FRISCO STREET
Practice Address - Street 2:
Practice Address - City:THOMAS
Practice Address - State:OK
Practice Address - Zip Code:73669
Practice Address - Country:US
Practice Address - Phone:580-661-3260
Practice Address - Fax:580-661-3263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200054800AMedicaid
OK375240Medicare Oscar/Certification