Provider Demographics
NPI:1437221215
Name:LEEDEY PUBLIC WORKS AUTHORITY
Entity type:Organization
Organization Name:LEEDEY PUBLIC WORKS AUTHORITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN OF THE BOARD
Authorized Official - Prefix:MR
Authorized Official - First Name:ORIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-488-2006
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:LEEDEY
Mailing Address - State:OK
Mailing Address - Zip Code:73654-0010
Mailing Address - Country:US
Mailing Address - Phone:580-488-2006
Mailing Address - Fax:580-488-3370
Practice Address - Street 1:901 DEWEY RD
Practice Address - Street 2:
Practice Address - City:LEEDEY
Practice Address - State:OK
Practice Address - Zip Code:73654-0010
Practice Address - Country:US
Practice Address - Phone:580-488-2006
Practice Address - Fax:580-488-3370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH2203313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility