Provider Demographics
NPI:1881802569
Name:EASTERN OKLAHOMA NURSING HOMES, INC.
Entity type:Organization
Organization Name:EASTERN OKLAHOMA NURSING HOMES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:REAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-465-2255
Mailing Address - Street 1:PO BOX 508
Mailing Address - Street 2:
Mailing Address - City:WILBURTON
Mailing Address - State:OK
Mailing Address - Zip Code:74578-0508
Mailing Address - Country:US
Mailing Address - Phone:918-465-2255
Mailing Address - Fax:918-465-3490
Practice Address - Street 1:103 SW 9TH ST
Practice Address - Street 2:
Practice Address - City:WILBURTON
Practice Address - State:OK
Practice Address - Zip Code:74578-3604
Practice Address - Country:US
Practice Address - Phone:918-465-2255
Practice Address - Fax:918-465-3490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH3902-3902313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK37E139Medicaid
OK=========OtherFEDERAL IDENTIFICATION