Basic Information
Provider Information
NPI: 1578518494
EntityType: 2
ReplacementNPI:  
OrganizationName: CHEROKEE COUNTY NURSING CENTER INC
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Mailing Information
Address1: 415 ROGERS AVE
Address2:  
City: FORT SMITH
State: AR
PostalCode: 729011903
CountryCode: US
TelephoneNumber: 4797834672
FaxNumber: 4797832217
Practice Location
Address1: 1504 N CEDAR AVE
Address2:  
City: TAHLEQUAH
State: OK
PostalCode: 744646700
CountryCode: US
TelephoneNumber: 9184563456
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Other Information
ProviderEnumerationDate: 05/23/2006
LastUpdateDate: 04/16/2020
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: MORTON
AuthorizedOfficialFirstName: MICHAEL
AuthorizedOfficialMiddleName: S.
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 4797834672
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MR.
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NPICertificationDate: 04/16/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
314000000XNH1104-1104OKY Nursing & Custodial Care FacilitiesSkilled Nursing Facility 

No ID Information.


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