Healthcare Provider Details

I. General information

NPI: 1801287982
Provider Name (Legal Business Name): SOUTHERN HILLS REHAB CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2015
Last Update Date: 05/13/2021
Certification Date: 05/13/2021
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 TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: LANCE BALLER
Title or Position: CEO
Credential:
Phone: 303-449-2100