Provider Demographics
NPI:1922172113
Name:UNITED METHODIST RETIREMENT & HEALTH CARE CENTER, INC.
Entity Type:Organization
Organization Name:UNITED METHODIST RETIREMENT & HEALTH CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:SEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-323-0912
Mailing Address - Street 1:2316 W MODELLE AVE
Mailing Address - Street 2:PO BOX 578
Mailing Address - City:CLINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73601-3722
Mailing Address - Country:US
Mailing Address - Phone:580-323-0912
Mailing Address - Fax:580-323-4935
Practice Address - Street 1:2316 W MODELLE AVE
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-3722
Practice Address - Country:US
Practice Address - Phone:580-323-0912
Practice Address - Fax:580-323-4935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100773400AMedicaid
OK100773400AMedicaid