Healthcare Provider Details

I. General information

NPI: 1437505351
Provider Name (Legal Business Name): SKYLINE HEIGHTS OPERATING CO LLC IN RECEIVERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2016
Last Update Date: 06/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6202 E 61ST ST
TULSA OK
74136-2119
US

IV. Provider business mailing address

401 S BOSTON AVE SUITE 2200
TULSA OK
74103-4016
US

V. Phone/Fax

Practice location:
  • Phone: 918-494-8830
  • Fax:
Mailing address:
  • Phone: 918-728-3340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHARLES DAVID RHOADES
Title or Position: RECEIVER
Credential:
Phone: 918-728-3340