Provider Demographics
NPI:1699007534
Name:CONHOLD OF CATOOSA LLC
Entity type:Organization
Organization Name:CONHOLD OF CATOOSA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:F
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:JR
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 1:801 N 193RD EAST AVE
Practice Address - Street 2:
Practice Address - City:CATOOSA
Practice Address - State:OK
Practice Address - Zip Code:74015-3066
Practice Address - Country:US
Practice Address - Phone:918-266-5500
Practice Address - Fax:918-266-7600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-03
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH6604-6604314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility