Basic Information
| Provider Information | |||||||||
| NPI: | 1396055190 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHRE, LLC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 9 | ||||||||
| Address2: | |||||||||
| City: | SALLISAW | ||||||||
| State: | OK | ||||||||
| PostalCode: | 749550009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9187760033 | ||||||||
| FaxNumber: | 9187749345 | ||||||||
| Practice Location | |||||||||
| Address1: | 30049 E 151ST ST S | ||||||||
| Address2: | |||||||||
| City: | COWETA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 744294544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184862166 | ||||||||
| FaxNumber: | 9184866308 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2010 | ||||||||
| LastUpdateDate: | 10/14/2010 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | PARISH | ||||||||
| AuthorizedOfficialFirstName: | MELVA | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | CPA | ||||||||
| AuthorizedOfficialTelephone: | 9187760033 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | APPLIED FOR | OK | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.