Conhold of Ponca LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

NH3607-3607 Issued in OK

Legal business name

CONHOLD OF PONCA LLC

Doing business as

Shawn Manor Nursing Home

Practice address

2024 Turner St
Ponca City, OK 74604-2732

Phone

(580) 765-3364

Fax

(580) 765-3376

NPI assigned

Mar 10, 2011

Last updated

Mar 21, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. James Frank Sullivan

Title

Owner

Phone

(918) 774-9696

Specialties & licenses 1

Addresses

Other names 1

• SHAWN MANOR NURSING HOME Doing business as

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124326434. Details of each certification follow.

• CCN 375194 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 375194

Legal name

CONHOLD OF PONCA LLC

Doing business as

SHAWN MANOR NURSING HOME

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Jan 16, 1995

Last certification

Nov 20, 2024

Beds

96

Ownership / control type

Corporation

Multi-facility organization

Triacle Managed Companies

Most recent change of ownership

Dec 10, 2010

Organization structure

LLCProprietary

Incorporated

May 21, 2009 in OK

Enrollment address

2024 Turner St
Ponca City, OK 74604-2732

Nursing home name

SHAWN MANOR NURSING HOME

Affiliated entity

CONHOLD

Listed as

Shawn Manor Nursing HomeCCN 375194 · All quality measures

Overall star rating

5 of 5

Health inspections

5 of 5

Staffing

2 of 5

Quality measures

4 of 5

Type

Medicare and Medicaid

Ownership

For profit - Corporation

Certified

Jan 16, 1995

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

9653.7 residents per day on average

Chain

Conhold5 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

Tax ID family

Conhold of Ponca LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Conhold of Ponca, LLC

  • Skilled Nursing Facility
  • Ponca City, OK
  • NPI 1871892109
  NPD tax ID

All disclosed owners & managing parties 5

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Joseph Michael Moore, MD

  • Internal Medicine Physician
  • Tulsa, OK
  • NPI 1104853142
  NPD (past)
• Rodger Brannon Spillars, M.D.

  • Internal Medicine Physician
  • Tulsa, OK
  • NPI 1679508568
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1299715200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300665600000",
    "number": "1124326434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2024 TURNER ST",
            "city": "PONCA CITY",
            "state": "OK",
            "postal_code": "746042732",
            "telephone_number": "580-765-3364",
            "fax_number": "580-765-3376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2024 TURNER ST",
            "city": "PONCA CITY",
            "state": "OK",
            "postal_code": "746042732",
            "telephone_number": "580-765-3364",
            "fax_number": "580-765-3376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONHOLD OF PONCA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-10",
        "last_updated": "2011-03-21",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "FRANK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "918-774-9696",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OK",
            "license": "NH3607-3607",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SHAWN MANOR NURSING HOME",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Texanna Coleman
• Shaleen Fay Colton
• Jennifer Lynn Combest
• Lena Kathryn Combs
• Complete Vision Care, PLLC
• Conhold of Ponca, LLC
• Kristy Connell
• Reggie Cooley, DDS
• Paige Marie Cordova, LPN
• Andrew Coufal, OD

• Skilled Nursing Facility in Ponca City, OK
• Providers in Ponca City, OK by specialty
• Skilled Nursing Facility in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.