Provider Demographics
NPI:1902946346
Name:BLEVINS RETIREMENT & CARE CENTER L L C
Entity Type:Organization
Organization Name:BLEVINS RETIREMENT & CARE CENTER L L C
Other - Org Name:BLEVINS RETIREMENT & CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-967-9285
Mailing Address - Street 1:1220 E ELECTRIC AVE
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-3832
Mailing Address - Country:US
Mailing Address - Phone:918-423-9095
Mailing Address - Fax:918-423-1317
Practice Address - Street 1:1220 E ELECTRIC AVE
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-3832
Practice Address - Country:US
Practice Address - Phone:918-423-9095
Practice Address - Fax:918-423-1317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK100778160A313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100778160AMedicaid
OK375384Medicare Oscar/Certification