Healthcare Provider Details

I. General information

NPI: 1316930589
Provider Name (Legal Business Name): SOUTHERN HILLS NURSING CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 08/22/2020
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

3073 HORSESHOE DR S STE 102
NAPLES FL
34104-6144
US

V. Phone/Fax

Practice location:
  • Phone: 918-496-3963
  • Fax: 918-496-0774
Mailing address:
  • Phone: 239-963-3400
  • Fax: 239-963-3401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH72277227
License Number StateOK

VIII. Authorized Official

Name: MR. THOMAS E RAWLES JR.
Title or Position: VP
Credential:
Phone: 239-659-4900