Provider Demographics
NPI:1912994997
Name:SHAMROCK CARE CENTERS LLC
Entity Type:Organization
Organization Name:SHAMROCK CARE CENTERS LLC
Other - Org Name:FIRST SHAMROCK CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
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:479-769-5535
Mailing Address - Street 1:1415 S. MAIN
Mailing Address - Street 2:
Mailing Address - City:KINGFISHER
Mailing Address - State:OK
Mailing Address - Zip Code:73750
Mailing Address - Country:US
Mailing Address - Phone:405-375-3157
Mailing Address - Fax:
Practice Address - Street 1:1415 S MAIN ST
Practice Address - Street 2:
Practice Address - City:KINGFISHER
Practice Address - State:OK
Practice Address - Zip Code:73750-4403
Practice Address - Country:US
Practice Address - Phone:405-375-3157
Practice Address - Fax:405-375-6078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100778600AMedicaid
OK100778600AMedicaid