Basic Information
| Provider Information | |||||||||
| NPI: | 1093837767 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SAYRE HEALTH CARE INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HENSLEY NURSING HOME | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | HIGHWAY 152 BOX 465 | ||||||||
| Address2: | |||||||||
| City: | SAYRE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 736620465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5809282494 | ||||||||
| FaxNumber: | 5809282495 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 QUARTER MILE E OF COURT HOUSE | ||||||||
| Address2: | |||||||||
| City: | SAYRE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73662 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5809282494 | ||||||||
| FaxNumber: | 5809282495 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2007 | ||||||||
| LastUpdateDate: | 04/01/2010 | ||||||||
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| AuthorizedOfficialLastName: | HENSLEY | ||||||||
| AuthorizedOfficialFirstName: | DALE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 5809282494 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | NH0502-0502 | OK | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 100777390A | 05 | OK | MEDICAID |