Healthcare Provider Details

I. General information

NPI: 1699569178
Provider Name (Legal Business Name): SALLISAW STATE VETERANS HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2025
Last Update Date: 04/08/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2343 S KERR BLVD
SALLISAW OK
74955
US

IV. Provider business mailing address

3001 W BLUE STARR DR
CLAREMORE OK
74017-2544
US

V. Phone/Fax

Practice location:
  • Phone: 918-774-4859
  • Fax:
Mailing address:
  • Phone: 405-255-8891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CAMI MCKINNEY
Title or Position: COMPLIANCE DIRECTOR
Credential:
Phone: 405-255-8891