Provider Demographics
NPI:1457348450
Name:COLONIAL CARE CENTER, LLC
Entity Type:Organization
Organization Name:COLONIAL CARE CENTER, LLC
Other - Org Name:MEADOWBROOK NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:BRANDON
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-235-6443
Mailing Address - Street 1:113 E JONES ST
Mailing Address - Street 2:
Mailing Address - City:CHOUTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74337-2839
Mailing Address - Country:US
Mailing Address - Phone:918-476-8918
Mailing Address - Fax:918-476-8960
Practice Address - Street 1:113 E JONES ST
Practice Address - Street 2:
Practice Address - City:CHOUTEAU
Practice Address - State:OK
Practice Address - Zip Code:74337-2839
Practice Address - Country:US
Practice Address - Phone:918-476-8918
Practice Address - Fax:918-476-8960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH4903314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK375276Medicare Oscar/Certification
OK100772240AMedicaid