Provider Demographics
NPI:1336258409
Name:FARWEST HEALTHCARE INC.
Entity Type:Organization
Organization Name:FARWEST HEALTHCARE INC.
Other - Org Name:BELL AVENUE NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SEC/TREAS
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:DOUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-333-9545
Mailing Address - Street 1:2301 BELL AVE
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73644-2254
Mailing Address - Country:US
Mailing Address - Phone:580-225-3335
Mailing Address - Fax:580-225-6383
Practice Address - Street 1:2301 BELL AVE
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-2254
Practice Address - Country:US
Practice Address - Phone:580-225-3335
Practice Address - Fax:580-225-6383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH05050505313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK030378262OtherTAX ID
OK100770720AMedicaid
OK375399Medicare ID - Type Unspecified
OK030378262OtherTAX ID