Provider Demographics
NPI:1548261654
Name:INOLA HEALTH CARE CENTER, INC
Entity type:Organization
Organization Name:INOLA HEALTH CARE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:CHILDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-543-8800
Mailing Address - Street 1:400 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:INOLA
Mailing Address - State:OK
Mailing Address - Zip Code:74036-9424
Mailing Address - Country:US
Mailing Address - Phone:918-543-8800
Mailing Address - Fax:918-543-8801
Practice Address - Street 1:400 N BROADWAY
Practice Address - Street 2:
Practice Address - City:INOLA
Practice Address - State:OK
Practice Address - Zip Code:74036-9424
Practice Address - Country:US
Practice Address - Phone:918-543-8800
Practice Address - Fax:918-543-8801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH66066606314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK375449Medicare ID - Type Unspecified