Healthcare Provider Details

I. General information

NPI: 1497723621
Provider Name (Legal Business Name): CPC-SHERWOOD MANOR, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 05/08/2012
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

2416 W 51ST ST
TULSA OK
74107-7700
US

V. Phone/Fax

Practice location:
  • Phone: 918-446-4284
  • Fax: 918-445-8811
Mailing address:
  • Phone: 918-446-4284
  • Fax: 918-445-8811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH72257225
License Number StateOK

VIII. Authorized Official

Name: MR. KEVIN BRADLEY POUND
Title or Position: REGIONAL DIRECTOR
Credential:
Phone: 228-861-7598