Healthcare Provider Details

I. General information

NPI: 1396055190
Provider Name (Legal Business Name): CHRE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2010
Last Update Date: 10/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30049 E 151ST ST S
COWETA OK
74429-4544
US

IV. Provider business mailing address

PO BOX 9
SALLISAW OK
74955-0009
US

V. Phone/Fax

Practice location:
  • Phone: 918-486-2166
  • Fax: 918-486-6308
Mailing address:
  • Phone: 918-776-0033
  • Fax: 918-774-9345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MELVA J PARISH
Title or Position: CPA
Credential:
Phone: 918-776-0033