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COAL COUNTY EXTENDED CARE INCORPORATED NPI 1639178130


NPI Information

NPI: 1639178130
Provider Name: COAL COUNTY EXTENDED CARE INCORPORATED

Doing Business As: RUTH WILSON HURLEY MANOR

Classification: Nursing Facility/Intermediate Care Facility - 313M00000X
Entity Type: Organization

CLIA Number: 37D0684534

Address:
7 N COVINGTON ST
COALGATE, OK
ZIP 74538
Phone: (580) 927-2000
Get Directions

COAL COUNTY EXTENDED CARE INCORPORATED is a nursing facility intermediate care facility in Coalgate, OK. The provider is an institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals. COAL COUNTY EXTENDED CARE INCORPORATED NPI is 1639178130. The provider is registered as an organization entity type.
The provider Is Doing Business As Ruth Wilson Hurley Manor.

The provider's business location address is:

7 N COVINGTON ST
COALGATE, OK
ZIP 74538-001
Phone: (580) 927-2000
Fax: (580) 927-9940

The provider's authorized official is Trent A. Bourland .
The authorized official title is Chief Executive Officer and has the following contact phone number (580) 927-2327.

The CLIA number assigned to this NPI record is 37D0684534 - skilled nursing facility/nursing facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/18/2005 and was last updated on 7/7/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1314000000XSkilled Nursing FacilityNH1501-1501OKLAHOMANo
2313M00000XNursing Facility/Intermediate Care FacilityNH1501-1501OKLAHOMAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1100774650AMEDICAIDOKLAHOMA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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