Provider Demographics
NPI:1689234627
Name:OAK HILLS CARE CENTER RECEIVERSHIP , LLC
Entity Type:Organization
Organization Name:OAK HILLS CARE CENTER RECEIVERSHIP , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECEIVER
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-769-7990
Mailing Address - Street 1:PO BOX 1218
Mailing Address - Street 2:
Mailing Address - City:NICOMA PARK
Mailing Address - State:OK
Mailing Address - Zip Code:73066-1218
Mailing Address - Country:US
Mailing Address - Phone:405-769-7990
Mailing Address - Fax:405-769-7970
Practice Address - Street 1:1100 GEORGIA ST
Practice Address - Street 2:
Practice Address - City:JONES
Practice Address - State:OK
Practice Address - Zip Code:73049-7556
Practice Address - Country:US
Practice Address - Phone:405-399-2296
Practice Address - Fax:405-399-5037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility