Healthcare Provider Details

I. General information

NPI: 1003752692
Provider Name (Legal Business Name): CP SNF OPS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W FRONTAGE RD
OKEMAH OK
74859-6442
US

IV. Provider business mailing address

1305 SE ADAMS ST
IDABEL OK
74745-5240
US

V. Phone/Fax

Practice location:
  • Phone: 918-623-1936
  • Fax:
Mailing address:
  • Phone: 580-286-1065
  • Fax: 580-286-3926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: KATHY SUZETTE BAUCOM
Title or Position: REGIONAL DIRECTOR
Credential:
Phone: 479-312-8280