NPI 1124359047

3c Old Fashion Boarding Home

Organisation Assisted Living Facility (Mental Illness) Prague, OK

Practice location

Address: 719 S Jim Thorpe Blvd Nbu 1706, Prague, OK 74864-3505
Phone: (405) 567-2280
Fax: (405) 567-2280

Authorised official

Name: Jvon Cook
Title: Owner
Phone: (405) 567-7677

Registered specialties

Assisted Living Facility (Mental Illness) Primary

Nursing & Custodial Care Facilities Taxonomy 3104A0625X

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Registry record

NPI: 1124359047
Entity type: Organization
NPI issued: 15 Jan 2010
Record last updated: 15 Jan 2010

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.