NPIMap

Organization Active NPI

Peak Medical Oklahoma No. 4, Inc.

Doing business as South Park Care and Rehabilitation Center

  • Skilled Nursing Facility
  • Oklahoma City, OK
National Provider Identifier
1356396048
Registry record updated Sep 28, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
NH55325532 Issued in OK
Legal business name
PEAK MEDICAL OKLAHOMA NO. 4, INC.
Doing business as
South Park Care and Rehabilitation Center
Practice address
5725 S Ross Ave
Oklahoma City, OK 73119-5650
Phone
(405) 685-4791
Fax
(405) 685-0232
NPI assigned
May 23, 2006
Last updated
Sep 28, 2009By the provider in NPPES
Organization subpart
Yes
Parent organization
SUNBRIDGE HEALTHCARE CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 28, 2009

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

Authorized official

Name
William A. Mathies
Title
President Director
Phone
(505) 821-3355

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Alzheimer Center (Dementia Center) 311500000X NH55325532 OK
Skilled Nursing Facility 314000000X NH55325532 OK Primary

Addresses

Primary practice location

5725 S Ross Ave
Oklahoma City, OK 73119-5650

Mailing address

101 Sun Ave NE
Compliance Department
Albuquerque, NM 87109-4373
Phone (505) 468-5604

Other identifiers 1

IdentifierTypeStateIssuer
100779070AMedicaidOK

Other names 1

  • South Park Care and Rehabilitation Center Doing business as

National Provider Directory

National Provider Directory
Part of
Sunrise HLTH Care Corp

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1254096000000",
    "number": "1356396048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 SUN AVE NE",
            "address_2": "COMPLIANCE DEPARTMENT",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871094373",
            "telephone_number": "505-468-5604",
            "fax_number": "505-468-4681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5725 S ROSS AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731195650",
            "telephone_number": "405-685-4791",
            "fax_number": "405-685-0232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEAK MEDICAL OKLAHOMA NO. 4, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SUNBRIDGE HEALTHCARE CORPORATION",
        "enumeration_date": "2006-05-23",
        "last_updated": "2009-09-28",
        "status": "A",
        "authorized_official_last_name": "MATHIES",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "PRESIDENT DIRECTOR",
        "authorized_official_telephone_number": "505-821-3355"
    },
    "taxonomies": [
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": "OK",
            "license": "NH55325532",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OK",
            "license": "NH55325532",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100779070A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Park Care and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oklahoma City, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.