Healthcare Provider Details

I. General information

NPI: 1992207351
Provider Name (Legal Business Name): HOLIDAY HEIGHTS OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2018
Last Update Date: 01/18/2021
Certification Date: 01/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E DALE ST
NORMAN OK
73069-8737
US

IV. Provider business mailing address

4350 WILL ROGERS PKWY STE 300
OKLAHOMA CITY OK
73108-1839
US

V. Phone/Fax

Practice location:
  • Phone: 405-321-7932
  • Fax:
Mailing address:
  • Phone: 405-943-1144
  • Fax: 405-639-2742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License NumberNH1403
License Number StateOK

VIII. Authorized Official

Name: BRETT COBLE
Title or Position: PRESIDENT
Credential:
Phone: 405-943-1144