SH CCRC, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

NH7227-7227 Issued in OK

Legal business name

SH CCRC, LLC

Practice address

5170 S Vandalia Ave
Tulsa, OK 74135

Phone

(918) 496-3963

Fax

(918) 496-0774

NPI assigned

May 26, 2009

Organization subpart

No

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

Authorized official

Name

Ms. Dorene M Ford

Title

Director of Mis

Phone

(239) 963-3400

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• SOUTHERN HILLS REHABILITATION CENTER Doing business as

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

{
    "created_epoch": "1243296000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1526256000000",
    "number": "1992930614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 CENTREPARK BLVD STE 810",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334017412",
            "telephone_number": "239-963-3400",
            "fax_number": "239-963-3401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5170 S VANDALIA AVE",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "74135",
            "telephone_number": "918-496-3963",
            "fax_number": "918-496-0774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SH CCRC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-26",
        "last_updated": "2018-05-14",
        "status": "A",
        "authorized_official_last_name": "FORD",
        "authorized_official_first_name": "DORENE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "DIRECTOR OF MIS",
        "authorized_official_telephone_number": "239-963-3400",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OK",
            "license": "NH7227-7227",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100774500A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SOUTHERN HILLS REHABILITATION CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SOUTHERN HILLS REHABILITATION CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Lou Seymore
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• Ahmed Shaban
• Mohammed Shaban, DO
• L Kent Shacklett, D.D.S., M.S.D.
• Anna Claire Shadid
• David L Shadid, DO

• Skilled Nursing Facility in Tulsa, OK
• Providers in Tulsa, 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 May 14, 2018; 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.