1699756403 NPI number — BEAVER COUNTY NURSING HOME

Table of content: NICOLE KUTIL ATR, LPCC (NPI 1922798537)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699756403 NPI number — BEAVER COUNTY NURSING HOME

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEAVER COUNTY NURSING HOME
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699756403
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 220
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEAVER
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73932-0220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-625-4571
Provider Business Mailing Address Fax Number:
580-625-4891

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 EAST 8TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEAVER
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73932
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-625-4571
Provider Business Practice Location Address Fax Number:
580-625-4891
Provider Enumeration Date:
11/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
ARLENE
Authorized Official Middle Name:
LAROYCE
Authorized Official Title or Position:
BUSINESS OFFICE MANAGER
Authorized Official Telephone Number:
580-625-4571

Provider Taxonomy Codes

  • Taxonomy code: 313M00000X , with the licence number:  NH0401-0401 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100771550A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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