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General NPI Number Information
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NPI Number | 1902199714
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Entity Type | Organization
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Legal Business Name | CONHOLD OF BARTLESVILLE, LLC
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Dates
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Enumeration Date | 05/26/2011
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Last Update Date | 12/15/2011
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Provider Practice Location Address
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Address Line | 6006 SE ADAMS BLVD
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City | BARTLESVILLE
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State | OK
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Zip | 74006-8960
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Country | US
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Telephone | 918-331-0550
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Fax |
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Provider Business Mailing Address
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Address Line | 6006 SE ADAMS BLVD
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City | BARTLESVILLE
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State | OK
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Zip | 74006-8960
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Country | US
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Telephone | 918-331-0550
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Fax | 918-331-0585
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Authorized Official
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Title or Position | OWNER, PARTNER
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Name | KITT WAKELEY
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Credential |
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Telephone | 405-550-1750
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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 | NH74006
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License Number State | OK
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