# HENRYETTA COMMUNITY SKILLED HEALTHCARE AND REHAB LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Henryetta Community Skilled Healthcare and Rehab, Henryetta Community Skilled Healthcare & Rehab, LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376993071
- **Authorized official:** DONNA SIMMONS (MANAGING MEMBER)
- **Authorized official phone:** (405) 380-6671

## Contact information

- **Practice address:** 212 NORTH ANTES, HENRYETTA, OK 74437
- **Practice address phone:** (918) 652-8797
- **Practice address fax:** (918) 652-0266
- **Mailing address:** 212 N ANTES AVE, HENRYETTA, OK 74437-7331
- **Mailing address phone:** (918) 652-8797
- **Mailing address fax:** (918) 652-0266

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | NH5602 | OK | Yes |

## Other

- **Enumeration date:** 06/14/2016
- **Last updated:** 09/19/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200662260A | — | OK |