Healthcare Provider Details

I. General information

NPI: 1285117150
Provider Name (Legal Business Name): SOUTHERN HILLS RETIREMENT CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2018
Last Update Date: 09/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5170 S VANDALIA AVE
TULSA OK
74135-4079
US

IV. Provider business mailing address

5170 S VANDALIA AVE
TULSA OK
74135-4079
US

V. Phone/Fax

Practice location:
  • Phone: 918-496-3963
  • Fax: 918-496-0774
Mailing address:
  • Phone: 918-496-3963
  • Fax: 918-496-0774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateOK

VIII. Authorized Official

Name: ZVI RHINE
Title or Position: MANAGER
Credential:
Phone: 423-877-2024