Healthcare Provider Details

I. General information

NPI: 1376993071
Provider Name (Legal Business Name): HENRYETTA COMMUNITY SKILLED HEALTHCARE AND REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2016
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 NORTH ANTES
HENRYETTA OK
74437
US

IV. Provider business mailing address

212 N ANTES AVE
HENRYETTA OK
74437-7331
US

V. Phone/Fax

Practice location:
  • Phone: 918-652-8797
  • Fax: 918-652-0266
Mailing address:
  • Phone: 918-652-8797
  • Fax: 918-652-0266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH5602
License Number StateOK

VIII. Authorized Official

Name: DONNA SIMMONS
Title or Position: MANAGING MEMBER
Credential:
Phone: 405-380-6671