Basic Information
| Provider Information | |||||||||
| NPI: | 1821679812 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SPRINGHILL HEALTHCARE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 444991 EAST LOOP ROAD | ||||||||
| Address2: | |||||||||
| City: | GORE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4792505558 | ||||||||
| FaxNumber: | 4797156922 | ||||||||
| Practice Location | |||||||||
| Address1: | 1400 W 1ST ST | ||||||||
| Address2: | |||||||||
| City: | WEWOKA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 748845004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4792505558 | ||||||||
| FaxNumber: | 4797156922 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2021 | ||||||||
| LastUpdateDate: | 04/20/2021 | ||||||||
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| AuthorizedOfficialLastName: | MONTGOMERY | ||||||||
| AuthorizedOfficialFirstName: | AUBREY | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 4792369507 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 313M00000X | Y | Nursing & Custodial Care Facilities | Nursing Facility/Intermediate Care Facility |
ID Information
| ID | Type | State | Issuer | Description | NH6705-6705 | 01 | OK | NH LICENSE | OTHER |