Provider Demographics
NPI:1497723621
Name:CPC-SHERWOOD MANOR, INC.
Entity Type:Organization
Organization Name:CPC-SHERWOOD MANOR, INC.
Other - Org Name:SHERWOOD MANOR NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:POUND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-861-7598
Mailing Address - Street 1:2416 W 51ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74107-7700
Mailing Address - Country:US
Mailing Address - Phone:918-446-4284
Mailing Address - Fax:918-445-8811
Practice Address - Street 1:2416 W 51ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74107-7700
Practice Address - Country:US
Practice Address - Phone:918-446-4284
Practice Address - Fax:918-445-8811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH72257225314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100771290AMedicaid
OK100771290AMedicaid