Healthcare Provider Details

I. General information

NPI: 1902199714
Provider Name (Legal Business Name): CONHOLD OF BARTLESVILLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 12/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6006 SE ADAMS BLVD
BARTLESVILLE OK
74006-8960
US

IV. Provider business mailing address

6006 SE ADAMS BLVD
BARTLESVILLE OK
74006-8960
US

V. Phone/Fax

Practice location:
  • Phone: 918-331-0550
  • Fax:
Mailing address:
  • Phone: 918-331-0550
  • Fax: 918-331-0585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH74006
License Number StateOK

VIII. Authorized Official

Name: KITT WAKELEY
Title or Position: OWNER, PARTNER
Credential:
Phone: 405-550-1750