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MEADOW BROOK ICF/MR #2

Intermediate Care Mental Illness

Howe, Oklahoma

Provider NPI: 1164684957

Organization Information:
Organization Name:  MEADOW BROOK ICF/MR #2
Organization is not Subpart
Authorized Official:  TABITHA  BUNDY  ADMINISTRATOR  918-6583656

Practice Location:
1500 MEADOW LANE  HOWE, OK 74940 US
Tel: 918-658-3656  Fax: 918-658-3967

Business Mailing Address:
1500 MEADOW LANE  HOWE, OK 74940 US
Tel: 918-658-3656  Fax: 918-658-3967

Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y310500000XNursing & Custodial Care Facilities
Intermediate Care Facility, Mental Illness
OKNH4004-4004

Other Provider Identifiers:

IssuerNumberStateType
OKLAHOMA STATE DEPARTMENT OF HEALTHNH4004-4004OK01
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







MENTAL ILLNESS JOBS OK - Page 1



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