COUNTRYWOOD ASSISTED LIVING & MEMORY CARE, LLC (NPI# 1306041272) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306041272 |
| Entity Type | Organization |
| Organization Name | COUNTRYWOOD ASSISTED LIVING & MEMORY CARE, LLC |
| Practice Address |
1604 S 13th St Kingfisher OK 73750-4619 |
| Mailing Address |
78 Centennial Loop Eugene OR 97401-7900 |
| Practice Telephone | 4053755232 |
| Practice Fax Number | 4053755830 |
| Mailing Telephone | 5417473373 |
| Mailing Fax Number | 5417470673 |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2008-05-13 |
| Authorized Official Name | MR. JOHN HOLTZ (CONTROLLER) |
| Authorized Official Telephone | 5417473373 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 305S00000X | Point of Service | Managed Care Organizations |
| Street Address |
1604 S 13TH ST |
| City | KINGFISHER |
| State | OK |
| Zip Code | 73750-4619 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144843335 | Wc-countrywood Ops, LLC | Assisted Living Facility | 1604 S 13th St, Kingfisher, OK 73750-4619 | 2020-05-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992155386 | Jami Grantz | General Acute Care Hospital | 1000 Kingfisher Reg Hosp Dr, Kingfisher, OK 73750 | 2016-06-15 |
| 1083048417 | Mercy Hospital Kingfisher, Inc | General Acute Care Hospital | 1000 Kingfisher Regional Hospital Drive, Kingfisher, OK 73750 | 2013-08-21 |
| 1245544246 | Amber Lisette Davis | Occupational Therapist | 500 S. 9th Street, Kingfisher, OK 73750 | 2010-08-02 |
| 1881921310 | Diane Marie Minnis | Dietitian, Registered | 1000 Kingfisher Regional Hospital Dr, Kingfisher, OK 73750 | 2009-11-04 |
| 1366694663 | Shea Nicole Krablin | Speech-Language Pathologist | 401 West Bowman, Kingfisher, OK 73750 | 2008-10-17 |
| 1073719209 | Nathan Kelly Brown | Dentist | 2302 S Frontage Rd, Kingfisher, OK 73750 | 2007-06-25 |
| 1992849996 | Kingfisher Dental Pllc | Dentist | 2302 S. Frontage Rd, Kingfisher, OK 73750 | 2007-02-16 |
| 1942385075 | Ltrx Inc. | Pharmacy | 1308 S. Main Street, Kingfisher, OK 73750 | 2006-10-26 |
| 1497841175 | Gary E Palmer | Chiropractor | 723 S. Main Street, Kingfisher, OK 73750 | 2006-10-04 |
| 1356302947 | Bridget A. Keast | Physician Assistant | 1002 Hospital Drive, Kingfisher, OK 73750 | 2006-03-31 |
| Find all providers in zip 73750 | ||||
| Taxonomy Code | 305S00000X |
| Grouping | Managed Care Organizations |
| Classification | Point of Service |
| This product may also be called an open-ended HMO and offers a transition product incorporating features of both HMOs and PPOs. Beneficiaries are enrolled in an HMO but have the option to go outside the networks for an additional cost. |
| Notes: Source: "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 62 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184079014 | Raphael Bonelle | Point of Service | 12201 Garden Ct, Oklahoma City, OK 73170-4006 | 2016-04-28 |
| 1972988707 | Sandra Taylor | Point of Service | 906 W 9th Pl. South, Claremore, OK 74017-0000 | 2015-07-22 |
| 1639565153 | Ryian Reyes | Point of Service | 2101 N 14th, Suite 134, Ponca City, OK 74601 | 2015-04-10 |
| 1619374337 | His Arms Extended | Point of Service | 2358 County Road 1325, Blanchard, OK 73010-3522 | 2014-11-24 |
| 1114265576 | National Practitioners Services LLC | Point of Service | 5515 E 76th St, Tulsa, OK 74136-8429 | 2013-01-19 |
| 1962752659 | United Keetoowah Band Community Health Initiative, LLC | Point of Service | 2450 S Muskogee Ave, Tahlequah, OK 74464-5450 | 2012-09-11 |
| 1649547001 | Javersak Family Chiropractic | Point of Service | 1005 Shady Holw, 1005 Shady Hollow Ct, Mcalester, OK 74501-8342 | 2011-11-29 |
| 1588984553 | Mental Health Recovery | Point of Service | 2201 Nw 122nd St Apt 513, Oklahoma City, OK 73120-8405 | 2010-06-01 |
| 1144466962 | Lifeback Chiropractic Plc | Point of Service | 1101 N Harrison St Ste B, Shawnee, OK 74801-5205 | 2008-12-29 |
| 1780858654 | J.michael Wyatt Inc.p.c. | Point of Service | 736 Nw 63rd St, Oklahoma City, OK 73116-7602 | 2008-04-22 |
| Find all providers with the same taxonomy | ||||
| City | KINGFISHER |
| Zip Code | 73750 |
Please comment or provide details below to improve the information on COUNTRYWOOD ASSISTED LIVING & MEMORY CARE, LLC.
| 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.