Provider Demographics
NPI:1699756403
Name:BEAVER COUNTY NURSING HOME
Entity type:Organization
Organization Name:BEAVER COUNTY NURSING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ARLENE
Authorized Official - Middle Name:LAROYCE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-625-4571
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:OK
Mailing Address - Zip Code:73932-0220
Mailing Address - Country:US
Mailing Address - Phone:580-625-4571
Mailing Address - Fax:580-625-4891
Practice Address - Street 1:200 EAST 8TH STREET
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:OK
Practice Address - Zip Code:73932
Practice Address - Country:US
Practice Address - Phone:580-625-4571
Practice Address - Fax:580-625-4891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH0401-0401313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100771550AMedicaid
OK37E009Medicare ID - Type Unspecified