Provider Demographics
NPI:1821679812
Name:SPRINGHILL HEALTHCARE LLC
Entity Type:Organization
Organization Name:SPRINGHILL HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:AUBREY
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-236-9507
Mailing Address - Street 1:444991 EAST LOOP ROAD
Mailing Address - Street 2:
Mailing Address - City:GORE
Mailing Address - State:OK
Mailing Address - Zip Code:74435
Mailing Address - Country:US
Mailing Address - Phone:479-250-5558
Mailing Address - Fax:479-715-6922
Practice Address - Street 1:1400 W 1ST ST
Practice Address - Street 2:
Practice Address - City:WEWOKA
Practice Address - State:OK
Practice Address - Zip Code:74884-5004
Practice Address - Country:US
Practice Address - Phone:479-250-5558
Practice Address - Fax:479-715-6922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKNH6705-6705OtherNH LICENSE