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General NPI Number Information
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NPI Number | 1376993071
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Entity Type | Organization
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Legal Business Name | HENRYETTA COMMUNITY SKILLED HEALTHCARE AND REHAB LLC
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Dates
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Enumeration Date | 06/14/2016
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 212 NORTH ANTES
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City | HENRYETTA
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State | OK
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Zip | 74437
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Country | US
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Telephone | 918-652-8797
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Fax | 918-652-0266
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Provider Business Mailing Address
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Address Line | 212 N ANTES AVE
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City | HENRYETTA
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State | OK
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Zip | 74437-7331
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Country | US
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Telephone | 918-652-8797
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Fax | 918-652-0266
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DONNA SIMMONS
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Credential |
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Telephone | 405-380-6671
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | NH5602
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License Number State | OK
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