Provider Demographics
NPI:1871036616
Name:CHECOTAH NURSING AND REHABILITATION LLC
Entity Type:Organization
Organization Name:CHECOTAH NURSING AND REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BARNEY
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:ABBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-445-0074
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:HYDRO
Mailing Address - State:OK
Mailing Address - Zip Code:73048-0070
Mailing Address - Country:US
Mailing Address - Phone:866-219-3619
Mailing Address - Fax:
Practice Address - Street 1:321 SE 2ND ST
Practice Address - Street 2:
Practice Address - City:CHECOTAH
Practice Address - State:OK
Practice Address - Zip Code:74426-4005
Practice Address - Country:US
Practice Address - Phone:918-473-2251
Practice Address - Fax:918-473-6774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-28
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH4602-4602314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK375140Medicare Oscar/Certification