- Enrollment id
- O20240401000359
- Enrollment state
- OK
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1730863655
- Multiple npi flag
- N
- Ccn
- 375304
- Associate id
- 7214375997
- Organization name
- COWETA HEALTHCARE MANAGEMENT LLC
- Doing business as name
- COWETA CARE & REHAB CENTER
- Incorporation date
- 2023-05-04
- Incorporation state
- OK
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- COWETA CARE & REHAB CENTER
- Affiliation entity name
- MGM HEALTHCARE
- Affiliation entity id
- 348
- Address line 1
- 30049 E 151ST ST S
- City
- COWETA
- State
- OK
- Zip code
- 744294544