NPIMap

Organization Active NPI

Corn Heritage Village of Weatherford Inc

  • Nursing Facility/Intermediate Care Facility
  • Weatherford, OK
National Provider Identifier
1306809884
Registry record updated Jun 1, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X
License
NH2002 Issued in OK
Legal business name
CORN HERITAGE VILLAGE OF WEATHERFORD INC
Practice address
801 N Washington St
Weatherford, OK 73096-4032
Phone
(580) 772-3993
Fax
(580) 774-1032
NPI assigned
Apr 7, 2006
Last updated
Jun 1, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2009

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

Authorized official

Name
Martin Hall
Title
Executive Director
Phone
(580) 343-2295

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X NH2002 OK Primary

Addresses

Primary practice location

801 N Washington St
Weatherford, OK 73096-4032

Mailing address

801 N Washington St
Weatherford, OK 73096-4032
Phone (580) 772-3993

Other identifiers 1

IdentifierTypeStateIssuer
200076200AMedicaidOK

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090715000798 OK Part A Provider - Skilled Nursing Facility 9032261425 Practice locations: Weatherford, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1306809884. Details of each certification follow.

Skilled nursing facility certification: CCN 375530

Legal name
CORN HERITAGE VILLAGE OF WEATHERFORD INC
Doing business as
CORN HERITAGE VILLAGE AND REHAB OF WEATHERFORD
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jul 1, 2009
Last certification
Jan 23, 2025
Beds
81
Ownership / control type
Church Related
Multi-facility organization
Corn Heritage Village
Organization structure
CorporationNon-profit
Incorporated
Mar 6, 2009 in OK
Enrollment address
801 N Washington
Weatherford, OK 73096-4032
Nursing home name
CORN HERITAGE VILLAGE AND REHAB OF WEATHERFORD

Care Compare: Nursing home

Medicare Care Compare
Listed as
Corn Heritage Village and Rehab of WeatherfordCCN 375530 · All quality measures
Overall star rating
2 of 5
Health inspections
3 of 5
Staffing
2 of 5
Quality measures
1 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Church related
Certified
Jul 1, 2009
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
8151.7 residents per day on average
Penalties (3 years)
1Fines totaling $9,113

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
37D1066767Corn Heritage Village of Weatherford801 N Washington, Weatherford, OK 73096Certificate of waiverApr 1, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 20

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

NameRoleSinceShare
Individual Adp of the SNF Aug 1, 2023
Jonathan Peters Individual Corporate DirectorVice Chair Sep 30, 2019
Onshift Inc Organization, Dallas, TX LLC, Medical staffing company, For-profit Operational/Managerial Control Feb 1, 2025
Adp of the SNF Jun 25, 2025
Citizens Bank of Oklahoma Organization, Weatherford, OK Financial institution Operational/Managerial Control Jan 1, 2017
Adp of the SNF Jun 25, 2025
Legacy Bank Organization, Weatherford, OK Financial institution Operational/Managerial Control Jan 1, 2017
Adp of the SNF Jun 25, 2025
Marci Russell Individual Corporate DirectorBoard Member Jan 1, 2024
Dianna Waldrop Individual Operational/Managerial Control Jan 1, 2025
Bart Gossen Individual Corporate DirectorBoard Member Jan 1, 2024
Twomagnets LLC Organization, Walnut, CA Corporation, Medical staffing company, For-profit Operational/Managerial Control Apr 8, 2022
Adp of the SNF Jun 25, 2025
Michael E Aaron Individual Operational/Managerial Control May 1, 2021
Adp of the SNF May 12, 2025
Melissa Morgan Individual Operational/Managerial Control Jan 1, 2025
Josh Sawatzky Individual Operational/Managerial Control Jan 1, 2025
Aegis Therapies, Inc. Organization, Atlanta, GA Corporation, For-profit Operational/Managerial Control Oct 22, 2020
Adp of the SNF Jun 25, 2025
Zachary Williams Individual Operational/Managerial Control Jan 1, 2025
Forvis Mazars LLP Organization, Springfield, MO Consulting firm Operational/Managerial Control Jan 17, 2002
Adp of the SNF Jun 25, 2025
Jennifer Riley Individual Operational/Managerial Control Jan 1, 2025
Sheriffdeen M Raji Individual Operational/Managerial Control Jun 30, 2014
Adp of the SNF Jun 30, 2014
Howard Bartel Individual Corporate OfficerBoard Secretary Sep 1, 2013
Clair Redcay Individual Corporate OfficerBoard President Sep 27, 2021
Individual Adp of the SNF Sep 1, 2010

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 138

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 138

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

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": "1144368000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1243814400000",
    "number": "1306809884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 N WASHINGTON ST",
            "city": "WEATHERFORD",
            "state": "OK",
            "postal_code": "730964032",
            "telephone_number": "580-772-3993",
            "fax_number": "580-774-1032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 N WASHINGTON ST",
            "city": "WEATHERFORD",
            "state": "OK",
            "postal_code": "730964032",
            "telephone_number": "580-772-3993",
            "fax_number": "580-774-1032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORN HERITAGE VILLAGE OF WEATHERFORD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-07",
        "last_updated": "2009-06-01",
        "status": "A",
        "authorized_official_last_name": "HALL",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "580-343-2295"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "OK",
            "license": "NH2002",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200076200A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Weatherford, OK

Sources for this page

Verify at the official NPI Registry.