Basic Information
| Provider Information | |||||||||
| NPI: | 1881831774 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CLEVELAND AREA HOSPITAL HOLDINGS, INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | CLEVELAND AREA HOSPITAL SWING BED | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1401 WEST PAWNEE STRETT | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740203033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9183582501 | ||||||||
| FaxNumber: | 9183589274 | ||||||||
| Practice Location | |||||||||
| Address1: | 1401 WEST PAWNEE | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9183582501 | ||||||||
| FaxNumber: | 9183585526 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/14/2009 | ||||||||
| LastUpdateDate: | 09/27/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BENTON | ||||||||
| AuthorizedOfficialFirstName: | EDRED | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9183585647 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 09/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 275N00000X | 2270 | OK | Y | Hospital Units | Medicare Defined Swing Bed Unit |
No ID Information.