Organization
CONHOLD OF PONCA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES FRANKLIN SULLIVAN JR. J.D. (MANAGER/OWNER)
(918) 774-9696
Entity
Organization
Contact information
Practice address
2024 TURNER ROAD, PONCA CITY, OK 74601
(580) 765-3364
(580) 765-3376
Mailing address
111 EAST CHICKASAW, SALLISAW, OK 74955-0767
(918) 774-9696
(918) 774-9797
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NH3607-3607
STATE LICENSE NUMBER
OK
Enumeration date
03/25/2011
Last updated
03/25/2011
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