# SH CCRC, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** SOUTHERN HILLS REHABILITATION CENTER
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992930614
- **Authorized official:** MS. DORENE M FORD (DIRECTOR OF MIS)
- **Authorized official phone:** (239) 963-3400

## Contact information

- **Practice address:** 5170 S VANDALIA AVE, TULSA, OK 74135
- **Practice address phone:** (918) 496-3963
- **Practice address fax:** (918) 496-0774
- **Mailing address:** 1400 CENTREPARK BLVD STE 810, WEST PALM BEACH, FL 33401-7412
- **Mailing address phone:** (239) 963-3400
- **Mailing address fax:** (239) 963-3401

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | NH7227-7227 | OK | Yes |

## Other

- **Enumeration date:** 05/26/2009
- **Last updated:** 05/14/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100774500A | — | OK |