Provider Demographics
NPI:1710314612
Name:CONHOLD OF SAND SPRINGS, LLC
Entity Type:Organization
Organization Name:CONHOLD OF SAND SPRINGS, LLC
Other - Org Name:SAND SPRINGS NURSING AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NA
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-774-9696
Mailing Address - Street 1:111 E CHICKASAW AVE
Mailing Address - Street 2:
Mailing Address - City:SALLISAW
Mailing Address - State:OK
Mailing Address - Zip Code:74955-4625
Mailing Address - Country:US
Mailing Address - Phone:918-774-9696
Mailing Address - Fax:918-774-9797
Practice Address - Street 1:1025 N ADAMS RD
Practice Address - Street 2:
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063-8110
Practice Address - Country:US
Practice Address - Phone:918-245-5908
Practice Address - Fax:918-774-9797
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TENANT ONE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-10-09
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH7217-7217314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility