Provider Demographics
NPI:1164618591
Name:ROLLING HILLS CARE CENTER
Entity Type:Organization
Organization Name:ROLLING HILLS CARE CENTER
Other - Org Name:CCHR, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-266-5500
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:SALLISAW
Mailing Address - State:OK
Mailing Address - Zip Code:74955-0009
Mailing Address - Country:US
Mailing Address - Phone:918-776-0033
Mailing Address - Fax:918-776-0220
Practice Address - Street 1:801 N 193RD EAST AVE
Practice Address - Street 2:
Practice Address - City:CATOOSA
Practice Address - State:OK
Practice Address - Zip Code:74015-3066
Practice Address - Country:US
Practice Address - Phone:918-266-5500
Practice Address - Fax:918-266-7600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH6604-6604314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK375241Medicare Oscar/Certification