Basic Information
| Provider Information | |||||||||
| NPI: | 1285117150 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SOUTHERN HILLS RETIREMENT CENTER, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SOUTHERN HILLS ASSISTED LIVING | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5170 S VANDALIA AVE | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741354079 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184963963 | ||||||||
| FaxNumber: | 9184960774 | ||||||||
| Practice Location | |||||||||
| Address1: | 5170 S VANDALIA AVE | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741354079 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184963963 | ||||||||
| FaxNumber: | 9184960774 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2018 | ||||||||
| LastUpdateDate: | 09/07/2018 | ||||||||
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| AuthorizedOfficialLastName: | RHINE | ||||||||
| AuthorizedOfficialFirstName: | ZVI | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4238772024 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | OK | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.