NPIMap

Organization Active NPI

Harmon County Healthcare Trust Authority

Doing business as Colonial Manor II

  • Nursing Facility/Intermediate Care Facility
  • Hollis, OK
National Provider Identifier
1639166085
Registry record updated Jun 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X
License
NH2902-2902 Issued in OK
Legal business name
HARMON COUNTY HEALTHCARE TRUST AUTHORITY
Doing business as
Colonial Manor II
Practice address
120 W Versa St
Hollis, OK 73550-3046
Phone
(580) 688-9431
Fax
(580) 688-2491
NPI assigned
Sep 30, 2005
Last updated
Jun 17, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
HARMON COUNTY HEALTHCARE TRUST AUTHORITYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 17, 2008

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

Authorized official

Name
Ms. Hope Smith
Title
Administrator
Phone
(580) 688-9431

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X NH2902-2902 OK Primary

Addresses

Primary practice location

120 W Versa St
Hollis, OK 73550-3046

Mailing address

PO Box 793
Hollis, OK 73550-0793
Phone (580) 688-9431

Other identifiers 1

IdentifierTypeStateIssuer
100772150AMedicaidOK

Other names 1

  • Colonial Manor II Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Harmon County Health Ca2 organizations share this tax ID, including this one
Part of
Harmon County Health Ca

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1128038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213660800000",
    "number": "1639166085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 793",
            "city": "HOLLIS",
            "state": "OK",
            "postal_code": "735500793",
            "telephone_number": "580-688-9431",
            "fax_number": "580-688-2491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 W VERSA ST",
            "city": "HOLLIS",
            "state": "OK",
            "postal_code": "735503046",
            "telephone_number": "580-688-9431",
            "fax_number": "580-688-2491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARMON COUNTY HEALTHCARE TRUST AUTHORITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HARMON COUNTY HEALTHCARE TRUST AUTHORITY",
        "enumeration_date": "2005-09-30",
        "last_updated": "2008-06-17",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "HOPE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "580-688-9431",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "OK",
            "license": "NH2902-2902",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100772150A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Colonial Manor II",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hollis, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2008; 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.