- Enrollment id
- O20060306000077
- Enrollment state
- OK
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1336247873
- Multiple npi flag
- N
- Ccn
- 375293
- Associate id
- 0244246916
- Organization name
- SKIATOOK NURSING HOME LLC
- Doing business as name
- SKIATOOK NURSING HOME
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- SKIATOOK NURSING HOME,LLC
- Affiliation entity name
- OKLAHOMA NURSING HOMES, LTD.
- Affiliation entity id
- 384
- Address line 1
- 318 SOUTH CHERRY ST
- City
- SKIATOOK
- State
- OK
- Zip code
- 740701325