# CONHOLD OF PONCA, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1871892109
- **Authorized official:** MR. JAMES FRANKLIN SULLIVAN JR. J.D. (MANAGER/OWNER)
- **Authorized official phone:** (918) 774-9696

## Contact information

- **Practice address:** 2024 TURNER ROAD, PONCA CITY, OK 74601
- **Practice address phone:** (580) 765-3364
- **Practice address fax:** (580) 765-3376
- **Mailing address:** 111 EAST CHICKASAW, SALLISAW, OK 74955-0767
- **Mailing address phone:** (918) 774-9696
- **Mailing address fax:** (918) 774-9797

## Taxonomy

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

## Other

- **Enumeration date:** 03/25/2011
- **Last updated:** 03/25/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | NH3607-3607 | STATE LICENSE NUMBER | OK |