NPIMap

Organization Active NPI

Tidwell Healthcare, LLC

  • Nursing Facility/Intermediate Care Facility
  • Wilburton, OK
National Provider Identifier
1023430741
Registry record updated Dec 31, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X
License
NH3903-3903 Issued in OK
Legal business name
TIDWELL HEALTHCARE, LLC
Doing business as
Tidwell Living Center
Practice address
900 Ranchwood Dr
Wilburton, OK 74578-3630
Phone
(918) 465-5020
Fax
(918) 465-5007
NPI assigned
Jan 15, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 31, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Melissa C Tidwell, RN, MHA
Title
Owner
Phone
(918) 465-5020

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X NH3903-3903 OK Primary

Addresses

Primary practice location

900 Ranchwood Dr
Wilburton, OK 74578-3630

Mailing address

900 Ranchwood Dr
Wilburton, OK 74578-3630
Phone (918) 465-5020

Other identifiers 1

IdentifierTypeStateIssuer
200522320AMedicaidOK

Other names 1

  • Tidwell Living Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150323000533 OK Part A Provider - Skilled Nursing Facility 4880911304 Practice locations: Wilburton, OK

Skilled nursing facility certification: CCN 375563

Legal name
TIDWELL HEALTHCARE, LLC
Doing business as
TIDWELL LIVING CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Mar 23, 2015
Last certification
May 8, 2025
Beds
55
Ownership / control type
Individual
Organization structure
LLCProprietary
Incorporated
Aug 14, 2013 in OK
Enrollment address
900 Ranchwood Dr
Tidwell Living Center
Wilburton, OK 74578-3630
Nursing home name
TIDWELL LIVING CENTER

Care Compare: Nursing home

Medicare Care Compare
Listed as
Tidwell Living CenterCCN 375563 · All quality measures
Overall star rating
5 of 5
Health inspections
5 of 5
Staffing
4 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Individual
Certified
Mar 23, 2015
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
5532.4 residents per day on average

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
37D2082961Tidwell Living Center900 West Ranchwood Dr, Wilburton, OK 74578Certificate of waiverAug 25, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Melissa C Tidwell Individual 5% Or Greater Direct Ownership InterestOwner Dec 15, 2013 50%
Operational/Managerial ControlNursing Home Administrator Jan 1, 2015
OtherLLC Operating Manager Dec 15, 2013 50%
Darren Tidwell Individual 5% Or Greater Direct Ownership InterestOwner Dec 15, 2013 50%
OtherLLC Operating Secretary Dec 15, 2013 50%

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 3

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1389744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1451520000000",
    "number": "1023430741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 RANCHWOOD DR",
            "city": "WILBURTON",
            "state": "OK",
            "postal_code": "745783630",
            "telephone_number": "918-465-5020",
            "fax_number": "918-465-5007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 RANCHWOOD DR",
            "city": "WILBURTON",
            "state": "OK",
            "postal_code": "745783630",
            "telephone_number": "918-465-5020",
            "fax_number": "918-465-5007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDWELL HEALTHCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-15",
        "last_updated": "2015-12-31",
        "status": "A",
        "authorized_official_last_name": "TIDWELL",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "918-465-5020",
        "authorized_official_credential": "RN, MHA"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "OK",
            "license": "NH3903-3903",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200522320A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tidwell Living Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wilburton, OK

Sources for this page

Verify at the official NPI Registry.