Provider Demographics
NPI:1881831774
Name:CLEVELAND AREA HOSPITAL HOLDINGS, INC.
Entity Type:Organization
Organization Name:CLEVELAND AREA HOSPITAL HOLDINGS, INC.
Other - Org Name:CLEVELAND AREA HOSPITAL SWING BED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EDRED
Authorized Official - Middle Name:
Authorized Official - Last Name:BENTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-358-5647
Mailing Address - Street 1:1401 WEST PAWNEE STRETT
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OK
Mailing Address - Zip Code:74020-3033
Mailing Address - Country:US
Mailing Address - Phone:918-358-2501
Mailing Address - Fax:918-358-9274
Practice Address - Street 1:1401 WEST PAWNEE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OK
Practice Address - Zip Code:74020
Practice Address - Country:US
Practice Address - Phone:918-358-2501
Practice Address - Fax:918-358-5526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-14
Last Update Date:2020-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2270275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK37Z320Medicare PIN
OK37Z320Medicare UPIN