Idabel Health & Rehabilitation Center, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

NH4505-4505 Issued in OK

Legal business name

IDABEL HEALTH & REHABILITATION CENTER, LLC

Doing business as

Oak Grove Manor

Practice address

Highway 259 South
Idabel, OK 74745

Phone

(580) 286-2537

Fax

(580) 286-5480

NPI assigned

Feb 23, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. William E. Daves Jr.

Title

Managing Member & President

Phone

(580) 286-2537

Specialties & licenses 1

Addresses

Other names 1

• Oak Grove Manor Doing business as

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

{
    "created_epoch": "1172188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1053446542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 299",
            "city": "IDABEL",
            "state": "OK",
            "postal_code": "747450299",
            "telephone_number": "580-286-2537",
            "fax_number": "580-286-5480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "HIGHWAY 259 SOUTH",
            "city": "IDABEL",
            "state": "OK",
            "postal_code": "74745",
            "telephone_number": "580-286-2537",
            "fax_number": "580-286-5480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDABEL HEALTH & REHABILITATION CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DAVES",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "MANAGING MEMBER & PRESIDENT",
        "authorized_official_telephone_number": "580-286-2537",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OK",
            "license": "NH4505-4505",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Oak Grove Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Mary Jacque Ishcomer
• Deetra Jackson

• Skilled Nursing Facility in Idabel, OK
• Providers in Idabel, OK by specialty
• Skilled Nursing Facility in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.