Provider Demographics
NPI:1992778278
Name:CHECOTAH HOLDINGS, LLC
Entity type:Organization
Organization Name:CHECOTAH HOLDINGS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:K
Authorized Official - Last Name:KELSOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-473-5598
Mailing Address - Street 1:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:CHECOTAH
Mailing Address - State:OK
Mailing Address - Zip Code:74426-0429
Mailing Address - Country:US
Mailing Address - Phone:918-473-2251
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK313M00000X3140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKNH4602-4602Medicaid
OKNH4602-4602Medicaid