Provider Demographics
NPI:1952738163
Name:LATIMER COUNTY HOSPITAL RETIREMENT CENTER, LLC
Entity Type:Organization
Organization Name:LATIMER COUNTY HOSPITAL RETIREMENT CENTER, LLC
Other - Org Name:LATIMER COUNTY HOSPITAL RETIREMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIR PERSON
Authorized Official - Prefix:MR
Authorized Official - First Name:EARL
Authorized Official - Middle Name:
Authorized Official - Last Name:JEFFERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-465-5020
Mailing Address - Street 1:900 RANCHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WILBURTON
Mailing Address - State:OK
Mailing Address - Zip Code:74578-3630
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:900 RANCHWOOD DR
Practice Address - Street 2:
Practice Address - City:WILBURTON
Practice Address - State:OK
Practice Address - Zip Code:74578-3630
Practice Address - Country:US
Practice Address - Phone:918-465-5020
Practice Address - Fax:918-465-5007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH3903313M00000X
314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility