Basic Information
| Provider Information | |||||||||
| NPI: | 1710314612 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CONHOLD OF SAND SPRINGS, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SAND SPRINGS NURSING AND REHABILITATION | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 E CHICKASAW AVE | ||||||||
| Address2: | |||||||||
| City: | SALLISAW | ||||||||
| State: | OK | ||||||||
| PostalCode: | 749554625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9187749696 | ||||||||
| FaxNumber: | 9187749797 | ||||||||
| Practice Location | |||||||||
| Address1: | 1025 N ADAMS RD | ||||||||
| Address2: | |||||||||
| City: | SAND SPRINGS | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740638110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9182455908 | ||||||||
| FaxNumber: | 9187749797 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2013 | ||||||||
| LastUpdateDate: | 05/24/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| AuthorizedOfficialLastName: | THOMAS | ||||||||
| AuthorizedOfficialFirstName: | KIM | ||||||||
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| AuthorizedOfficialTitleorPosition: | NA | ||||||||
| AuthorizedOfficialTelephone: | 9187749696 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | TENANT ONE, LLC | ||||||||
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| NPICertificationDate: | 05/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | NH7217-7217 | OK | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.