- Enrollment id
- O20080222000454
- Enrollment state
- OK
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1871654087
- Multiple npi flag
- N
- Ccn
- 371529
- Associate id
- 1759282239
- Organization name
- SEQUOYAH COUNTY CITY OF SALLISAW HOSPITAL AUTHORITY
- Doing business as name
- NORTHEASTERN HEALTH SYSTEM SEQUOYAH
- Incorporation date
- 1966-07-01
- Incorporation state
- OK
- Organization type structure
- OTHER
- Organization other type text
- CITY COUNTY TRUST
- Proprietary nonprofit
- N
- Address line 1
- 213 E REDWOOD AVE
- City
- SALLISAW
- State
- OK
- Zip code
- 749552811