Basic Information
| Provider Information | |||||||||
| NPI: | 1326347519 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RECEIVER CARE LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MCLOUD NURSING CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 119 N ROBINSON AVE STE 400 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731024613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052720511 | ||||||||
| FaxNumber: | 4052720501 | ||||||||
| Practice Location | |||||||||
| Address1: | 701 S 8TH ST | ||||||||
| Address2: | |||||||||
| City: | MCLOUD | ||||||||
| State: | OK | ||||||||
| PostalCode: | 748518500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4059642961 | ||||||||
| FaxNumber: | 4059642964 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2011 | ||||||||
| LastUpdateDate: | 05/13/2011 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | PAYNE | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | R. | ||||||||
| AuthorizedOfficialTitleorPosition: | RECEIVER | ||||||||
| AuthorizedOfficialTelephone: | 4052720511 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | NH6309 | OK | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.