Provider Demographics
NPI:1902199714
Name:CONHOLD OF BARTLESVILLE, LLC
Entity type:Organization
Organization Name:CONHOLD OF BARTLESVILLE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:KITT
Authorized Official - Middle Name:
Authorized Official - Last Name:WAKELEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-550-1750
Mailing Address - Street 1:6006 SE ADAMS BLVD
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-8960
Mailing Address - Country:US
Mailing Address - Phone:918-331-0550
Mailing Address - Fax:918-331-0585
Practice Address - Street 1:6006 SE ADAMS BLVD
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-8960
Practice Address - Country:US
Practice Address - Phone:918-331-0550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-26
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH74006314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility