3C OLD FASHION BOARDING HOME (NPI# 1124359047) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124359047 |
| Entity Type | Organization |
| Organization Name | 3C OLD FASHION BOARDING HOME |
| Other Organization Name | 3C OLD FASHION BOARDING HOME |
| Practice Address |
719 S Jim Thorpe Blvd Nbu 1706 Prague OK 74864-3505 |
| Practice Telephone | 4055672280 |
| Practice Fax Number | 4055672280 |
| Mailing Telephone | 4055672280 |
| Mailing Fax Number | 4055672280 |
| Enumeration Date | 2010-01-15 |
| Last Update Date | 2010-01-15 |
| Authorized Official Name | JVON COOK (OWNER) |
| Authorized Official Telephone | 4055677677 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3104A0625X |
Assisted Living Facility Specialization: Assisted Living, Mental Illness |
OK | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| 3C Old Fashion Boarding Home | Doing Business As Name - Organization |
| Street Address |
719 S JIM THORPE BLVD NBU 1706 |
| City | PRAGUE |
| State | OK |
| Zip Code | 74864-3505 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336426378 | Pat Cook | Case Manager/Care Coordinator | 719 S Jim Thorpe Blvd, Prague, OK 74864-3505 | 2011-11-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275093098 | Bristow Endeavor Healthcare, LLC | Family Medicine | 1005 Mitacek Ave, Prague, OK 74864 | 2019-03-20 |
| 1699186817 | Helping Hands Home Care, Pllc | Case Management | 517 Jim Thorpe Blvd, Prague, OK 74864 | 2014-05-09 |
| 1386077121 | Jennifer Cook | Case Manager/Care Coordinator | 971 South Jim Thorpe Blvd, Prague, OK 74864 | 2013-08-15 |
| 1104103316 | Syretta Nikia Pittman | Case Manager/Care Coordinator | 1021 South Jim Thorpe Blvd, Prague, OK 74864 | 2011-11-16 |
| 1891009312 | Chasitee Qwinette Burdine | Contractor | 57533 Moccasin Trail Rd, Prague, OK 74864 | 2010-07-27 |
| 1689908261 | Charles Albert Cashman | Dentist | 1201 Jim Thorpe, Suite One, Prague, OK 74864 | 2009-09-29 |
| 1598911752 | Central Oklahoma Family Medical Center | Clinic/Center | Nbu 1706 Highway 99 South, Prague, OK 74864 | 2008-08-07 |
| 1679746234 | Mark Allen White | Counselor | 1025 Meadowbrook Ave, Prague, OK 74864 | 2008-04-03 |
| 1770751752 | Mary Ann Ward | Physician Assistant | 1322 Klabzuba Avenue, Prague, OK 74864 | 2008-02-13 |
| 1487837167 | Land of Hope | Community/Behavioral Health | 57523 Moccasin Trail Road, Prague, OK 74864 | 2007-12-17 |
| Find all providers in zip 74864 | ||||
| Taxonomy Code | 3104A0625X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| Specialization | Assisted Living, Mental Illness |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need special guidance, assistance and/or monitoring as the result of a psychiatric problem. This type of facility requires a staff with special training in mental health training and dealing with psychiatric emergencies. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558690792 | Burdine Inc | Assisted Living Facility | 214 S. Fourth St., Red Bird, OK 74458-0096 | 2009-12-17 |
| 1316142722 | Orchard Grove Rcf | Assisted Living Facility | 35010 S 4465 Rd, Vinita, OK 74301-6672 | 2007-06-16 |
| 1407051816 | Rambling Rose Dba Orchard Grove Rcf | Assisted Living Facility | 35164 S 4465 Rd, Vinita, OK 74301-6782 | 2007-06-16 |
| 1801918784 | Fair Oaks Residential Care LLC | Assisted Living Facility | 1330 N 3rd St, Langley, OK 74350 | 2007-04-04 |
| 1134250731 | Helen Farris | Assisted Living Facility | 17963 S 543 Road, Tahlequah, OK 74464 | 2007-03-08 |
| 1538299417 | Sugar Mountain Retreat, Inc. | Assisted Living Facility | 26403 S 581 Rd, Welling, OK 74471-2303 | 2007-03-07 |
| 1588265383 | Randi Lyn Todd | Assisted Living Facility | 618 E Canadian Ave, Vinita, OK 74301-3810 | 2020-11-06 |
| 1083215867 | Robert Frank Tipton Jr. | Assisted Living Facility | 618 E Canadian Ave, Vinita, OK 74301-3810 | 2020-11-06 |
| 1346685542 | Miller's Residential Care, LLC | Assisted Living Facility | 203 N Gunter St, Vinita, OK 74301-2903 | 2013-05-02 |
| 1700114253 | High Cedar Residential Care | Assisted Living Facility | 18601 Cedar Ln, Noble, OK 73068-5915 | 2009-11-20 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.