Healthcare Provider Details

I. General information

NPI: 1235085879
Provider Name (Legal Business Name): 5TH STREET SNF OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2026
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W 5TH ST
ADA OK
74820-3415
US

IV. Provider business mailing address

10913 S RIVER FRONT PKWY STE 290
SOUTH JORDAN UT
84095-3507
US

V. Phone/Fax

Practice location:
  • Phone: 580-436-1414
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: BRIAN RAMOS
Title or Position: MANAGER
Credential:
Phone: 580-436-1414