Healthcare Provider Details

I. General information

NPI: 1699007534
Provider Name (Legal Business Name): CONHOLD OF CATOOSA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2010
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N 193RD EAST AVE
CATOOSA OK
74015-3066
US

IV. Provider business mailing address

111 E CHICKASAW AVE
SALLISAW OK
74955-4625
US

V. Phone/Fax

Practice location:
  • Phone: 918-266-5500
  • Fax: 918-266-7600
Mailing address:
  • Phone: 918-774-9696
  • Fax: 918-774-9797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH6604-6604
License Number StateOK

VIII. Authorized Official

Name: MR. JAMES F SULLIVAN JR.
Title or Position: OWNER
Credential:
Phone: 918-774-9696