Organization
CHECOTAH HOLDINGS, LLC
Active
Other names
Checotah Manor
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DEBORAH K KELSOE (ADMINISTRATOR)
(918) 473-5598
Entity
Organization
Contact information
Practice address
321 SE 2ND ST, CHECOTAH, OK 74426-4005
(918) 473-2251
Mailing address
PO BOX 429, CHECOTAH, OK 74426-0429
(918) 473-2251
Taxonomy
Speciality
Code
Description
License number
State
3140N1450X
Pediatric Skilled Nursing Facility
Primary
313M00000X
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NH4602-4602
—
OK
Enumeration date
02/08/2006
Last updated
08/22/2020
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