MEADOW BROOK ICF/MR #2 (NPI# 1164684957) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164684957 |
| Entity Type | Organization |
| Organization Name | MEADOW BROOK ICF/MR #2 |
| Practice Address |
1500 Meadow Lane Howe OK 74940 |
| Practice Telephone | 9186583656 |
| Practice Fax Number | 9186583967 |
| Mailing Telephone | 9186583656 |
| Mailing Fax Number | 9186583967 |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2008-07-02 |
| Authorized Official Name | MS. TABITHA BUNDY (ADMINISTRATOR) |
| Authorized Official Telephone | 9186583656 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310500000X | Intermediate Care Facility, Mental Illness | NH4004-4004 | OK | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OK | OKLAHOMA STATE DEPARTMENT OF HEALTH | NH4004-4004 | 01 |
| Street Address |
1500 MEADOW LANE |
| City | HOWE |
| State | OK |
| Zip Code | 74940 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669015160 | Tamra Fitzer | Technician | 21444 East North Railroad St., Howe, OK 74940 | 2019-10-28 |
| 1467925073 | Charlotte Renae Smith | Technician | 21444 E N Railroad, Howe, OK 74940 | 2019-01-07 |
| 1063995199 | Tandi Lynn Jackson | Technician | 21444 East N Railroad, Howe, OK 74940 | 2018-09-14 |
| 1881177913 | Waldina Mercedes Stinson | Technician | 21444 East North, Railroad, Howe, OK 74940 | 2018-09-14 |
| 1811479355 | Amanda Marie Martin | Technician | 21444 East North Railroad, Howe, OK 74940 | 2018-08-31 |
| 1003208190 | Christine Emmons | Nurse's Aide | 21228 Meadow Lane, Howe, OK 74940 | 2015-02-26 |
| 1659762722 | Donna J Nelson | Technician | 21228 Meadow Ln, Howe, OK 74940 | 2015-02-11 |
| 1083021430 | Janet Farmer-stanley | Counselor | 21182 Meadow Lane, Howe, OK 74940 | 2014-07-17 |
| 1548526908 | Hope Johnson | Clinic/Center | 21182 Meadow Ln, Howe, OK 74940 | 2012-04-10 |
| 1649599531 | Timothy Matthew Nida | Counselor | 39995 Rnd. Mt Ln, Howe, OK 74940 | 2010-05-18 |
| Find all providers in zip 74940 | ||||
| Taxonomy Code | 310500000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Intermediate Care Facility, Mental Illness |
| A nursing facility that provides an intermediate level of nursing care to individuals whose functional abilities are significantly compromise by mental illness. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043834849 | Paddington Place Lcc | Intermediate Care Facility, Mental Illness | 3225 French Park Drive, Suite 6, Edmond, OK 73034 | 2020-06-08 |
| 1710501499 | Siloam Operations LLC | Intermediate Care Facility, Mental Illness | 3325 French Park Dr Ste 6, Edmond, OK 73034-7265 | 2020-05-29 |
| 1972852903 | Carl Albert Community Mental Health Center | Intermediate Care Facility, Mental Illness | 339 W Fillmore Ave, Mcalester, OK 74501-3604 | 2012-09-06 |
| 1316257496 | Arc Group Homes, Inc. | Intermediate Care Facility, Mental Illness | 5120 Jacquelyn Ln, Bartlesville, OK 74006-7732 | 2010-10-07 |
| 1922005230 | Hill Nursing Home, Inc. | Intermediate Care Facility, Mental Illness | 808 Nw Martin Luther King Ave, Idabel, OK 74745-4268 | 2005-06-30 |
| 1679806392 | Mccall's Chapel School Inc | Intermediate Care Facility, Mental Illness | 13546 County Road 3600, Ada, OK 74820-5378 | 2009-09-14 |
| 1619163771 | Mccall's Chapel School Inc | Intermediate Care Facility, Mental Illness | 13546 County Road 3600, Ada, OK 74820-5378 | 2007-09-21 |
| 1508052663 | Mccall's Chapel School Inc | Intermediate Care Facility, Mental Illness | 13546 County Road 3600, Ada, OK 74820-5378 | 2007-09-21 |
| 1871789933 | Mccall's Chapel School Inc | Intermediate Care Facility, Mental Illness | 13546 County Road 3600, Ada, OK 74820-5378 | 2007-09-21 |
| 1760678825 | Mccall's Chapel School Inc | Intermediate Care Facility, Mental Illness | 13546 County Road 3600, Ada, OK 74820-5378 | 2007-09-21 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.