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General NPI Number Information
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NPI Number | 1699569178
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Entity Type | Organization
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Legal Business Name | SALLISAW STATE VETERANS HOME
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Dates
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Enumeration Date | 04/08/2025
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Last Update Date | 04/08/2025
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Provider Practice Location Address
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Address Line | 2343 S KERR BLVD
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City | SALLISAW
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State | OK
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Zip | 74955
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Country | US
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Telephone | 918-774-4859
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Fax |
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Provider Business Mailing Address
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Address Line | 3001 W BLUE STARR DR
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City | CLAREMORE
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State | OK
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Zip | 74017-2544
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Country | US
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Telephone | 405-255-8891
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Fax |
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Authorized Official
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Title or Position | COMPLIANCE DIRECTOR
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Name | CAMI MCKINNEY
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Credential |
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Telephone | 405-255-8891
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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