Provider Demographics
NPI:1972685816
Name:ALVA HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:ALVA HOSPITAL AUTHORITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KANDICE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-430-3309
Mailing Address - Street 1:P.O. BOX 727
Mailing Address - Street 2:
Mailing Address - City:ALVA
Mailing Address - State:OK
Mailing Address - Zip Code:73717-0727
Mailing Address - Country:US
Mailing Address - Phone:580-327-2800
Mailing Address - Fax:580-430-3349
Practice Address - Street 1:730 SHARE DR
Practice Address - Street 2:
Practice Address - City:ALVA
Practice Address - State:OK
Practice Address - Zip Code:73717-3616
Practice Address - Country:US
Practice Address - Phone:580-327-2800
Practice Address - Fax:580-430-3349
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALVA HOSPITAL AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-19
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH7602-7602314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100773770AMedicaid