Healthcare Provider Details

I. General information

NPI: 1669777892
Provider Name (Legal Business Name): PF SOUTHERN HILLS SNF OPS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2011
Last Update Date: 06/16/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5721 S LEWIS AVE
TULSA OK
74105-7129
US

IV. Provider business mailing address

1500 WATERS RIDGE DR STE 200
LEWISVILLE TX
75057-6056
US

V. Phone/Fax

Practice location:
  • Phone: 918-447-6447
  • Fax: 918-447-9661
Mailing address:
  • Phone: 972-899-4126
  • Fax: 469-312-3796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberCC7207-7207
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License NumberCC7207-7207
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberCC7207-7207
License Number StateOK

VIII. Authorized Official

Name: JAMES M CHANCE
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 214-725-2837