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Contact Information

COAL COUNTY EXTENDED CARE INCORPORATED
7 N COVINGTON ST
COALGATE, OK74538-2001
 Phone: 580-927-2000
 Fax: 580-927-9940
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Nursing Facility/Intermediate Care Facility

313M00000X A3[10] Other Nursing Facility
 

Skilled Nursing Facility

314000000X A1[8] Skilled Nursing Facility
Indicates primary specialty

NPI Profile & details for COAL COUNTY EXTENDED CARE INCORPORATED

NPI Number 1639178130
LBN Legal business name COAL COUNTY EXTENDED CARE INCORPORATED
Authorized official TRENT BOURLAND - (CHIEF EXECUTIVE OFFICER)
Entity Organization
Organization subpart 1 No
Enumeration date 07/18/2005
Last updated 07/07/2020 - About 6 years ago
Identifiers
OK License # NH1501-1501
OK Medicaid 100774650A
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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