- Enrollment id
- O20200219001327
- Enrollment state
- OK
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1508406505
- Multiple npi flag
- N
- Ccn
- 375365
- Associate id
- 0143657890
- Organization name
- SP HEALTHCARE MANAGEMENT LLC
- Doing business as name
- SOUTH POINTE REHABILITATION AND CARE CENTER
- Incorporation date
- 2019-11-14
- Incorporation state
- OK
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- SOUTH POINTE REHABILITATION AND CARE CENTER
- Affiliation entity name
- MGM HEALTHCARE
- Affiliation entity id
- 348
- Address line 1
- 5725 SOUTH ROSS AVE
- City
- OKLAHOMA CITY
- State
- OK
- Zip code
- 731195650