NPI 1104618412

State of Oklahoma Human Services

Organisation Intellectual Disabilities Intermediate Care Facility Enid, OK

Practice location

Address: 2616 North 30th Street, Enid, OK 73701-8760
Phone: (580) 213-2700
Fax: (580) 358-8013

Authorised official

Name: David Ewing
Title: Licensed Nursing Home Administrator
Phone: (580) 805-1400

Registered specialties

Intellectual Disabilities Intermediate Care Facility Primary

Nursing & Custodial Care Facilities Taxonomy 315P00000X

Other Intermediate Care Facility, Intellectual Disabilities providers in Oklahoma →

Registry record

NPI: 1104618412
Entity type: Organization
NPI issued: 21 May 2025
Record last updated: 21 May 2025

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.