Healthcare Provider Details

I. General information

NPI: 1396029468
Provider Name (Legal Business Name): SHERWOOD-THS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2011
Last Update Date: 10/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2416 W 51ST ST
TULSA OK
74107-7700
US

IV. Provider business mailing address

838 CARTHAGE HWY
LEBANON TN
37087-4611
US

V. Phone/Fax

Practice location:
  • Phone: 918-446-4284
  • Fax:
Mailing address:
  • Phone: 615-417-8131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH7225-7225
License Number StateOK

VIII. Authorized Official

Name: MR. GORDON BONE
Title or Position: VICE-PRESIDENT
Credential:
Phone: 615-417-8131