| Organization Name: | MEADOW BROOK ICF/MR #2 |
| NPI Number: | 1164684957 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TABITHA BUNDY (ADMINISTRATOR) |
| Mailing Address: | 1500 Meadow Lane Howe |
| State: | OK US |
| Postal Code: | 74940 |
| Phone Number: | 9186583656 |
| Fax Number: | 9186583967 |
| NPI Enumeration Date: | 07/02/2008 |
| NPI Last Update Date: | 07/02/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 310500000X |
| License Number: | NH4004-4004 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Nursing & Custodial Care Facilities |
| Taxonomy Classification: | Intermediate Care Facility, Mental Illness |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A nursing facility that provides an intermediate level of nursing care to individuals whose functional abilities are significantly compromise by mental illness. |