Provider Demographics
NPI:1942392964
Name:WOLFE LIVING CENTER ASSOCIATION
Entity Type:Organization
Organization Name:WOLFE LIVING CENTER ASSOCIATION
Other - Org Name:THE WOLFE LIVING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUBBERTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-454-1400
Mailing Address - Street 1:18501 NE 63RD ST
Mailing Address - Street 2:
Mailing Address - City:HARRAH
Mailing Address - State:OK
Mailing Address - Zip Code:73045-8550
Mailing Address - Country:US
Mailing Address - Phone:405-454-1400
Mailing Address - Fax:405-454-1404
Practice Address - Street 1:18501 NE 63RD ST
Practice Address - Street 2:
Practice Address - City:HARRAH
Practice Address - State:OK
Practice Address - Zip Code:73045-8550
Practice Address - Country:US
Practice Address - Phone:405-454-1400
Practice Address - Fax:405-454-1404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH55485548314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK375472Medicare ID - Type Unspecified