PEAK MEDICAL OKLAHOMA NO. 4, INC. (NPI# 1356396048) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356396048 |
| Entity Type | Organization |
| Organization Name | PEAK MEDICAL OKLAHOMA NO. 4, INC. |
| Other Organization Name | SOUTH PARK CARE AND REHABILITATION CENTER |
| Practice Address |
5725 S Ross Ave Oklahoma City OK 73119-5650 |
| Mailing Address |
101 Sun Ave Ne Compliance Department Albuquerque NM 87109-4373 |
| Practice Telephone | 4056854791 |
| Practice Fax Number | 4056850232 |
| Mailing Telephone | 5054685604 |
| Mailing Fax Number | 5054684681 |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2009-09-28 |
| Authorized Official Name | WILLIAM A. MATHIES (PRESIDENT DIRECTOR) |
| Authorized Official Telephone | 5058213355 |
| Is Organization Subpart | Y |
| Parent Organization Name | SUNBRIDGE HEALTHCARE CORPORATION |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 311500000X | Alzheimer Center (Dementia Center) | NH55325532 | OK | Nursing & Custodial Care Facilities |
| Y | 314000000X | Skilled Nursing Facility | NH55325532 | OK | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OK | 100779070A | 05 |
| Other Name | Type Code |
|---|---|
| South Park Care and Rehabilitation Center | Doing Business As Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oklahoma Business Registrations | PEAK MEDICAL OKLAHOMA NO. 4, INC. | 1209 Orange St, Wilmington, DE 19801 |
| Street Address |
5725 S ROSS AVE |
| City | OKLAHOMA CITY |
| State | OK |
| Zip Code | 73119-5650 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508406505 | Sp Healthcare Management LLC | Skilled Nursing Facility | 5725 S Ross Ave, Oklahoma City, OK 73119-5650 | 2020-01-08 |
| 1316507114 | Latasha Day | Nurse Practitioner | 5725 S Ross Ave, Oklahoma City, OK 73119-5650 | 2019-06-14 |
| 1023433901 | Rhonda Mose | Nurse Practitioner | 5725 S Ross Ave, Oklahoma City, OK 73119-5650 | 2014-02-28 |
| 1245676923 | Sherrie Boren | Occupational Therapy Assistant | 5725 S Ross Ave, Oklahoma City, OK 73159 | 2013-05-21 |
| 1104262856 | Renee Lynn Molskness | Physical Therapy Assistant | 5725 S Ross Ave, Oklahoma City, OK 73170 | 2013-05-21 |
| 1558601294 | Kay Lynn Vincent | Physical Therapy Assistant | 5725 S Ross Ave, Oklahoma City, OK 73119-5650 | 2013-02-17 |
| 1902145121 | Geneva Molder | Occupational Therapy Assistant | 5725 S Ross Ave, Oklahoma City, OK 73119-5650 | 2013-02-07 |
| 1366788549 | South Park Health Care LLC | Skilled Nursing Facility | 5725 S Ross Ave, Oklahoma City, OK 73119-5650 | 2012-12-17 |
| 1851508154 | Stephanie Leann Garrett | Speech-Language Pathologist | 5725 S Ross Ave, Oklahoma City, OK 73119-5650 | 2007-05-17 |
| 1841407434 | Trudy T. Richardson | Physical Therapist | 5725 S Ross Ave, Oklahoma City, OK 73119-5650 | 2007-05-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376064592 | Focus Optical Inc. | Technician/Technologist | 12444 Nw 10th St, Bldg H Ste 101, Oklahoma City, OK 73119 | 2017-06-28 |
| 1730561176 | Elaine C Cheatham | Case Manager/Care Coordinator | 2124 Sw 48th Street, Oklahoma City, OK 73119 | 2015-06-22 |
| 1215326038 | Life and Hope Counseling LLC | Counselor | 2212 Sw 55th St, Okc, OK 73119 | 2015-01-16 |
| 1063761179 | Virginia Sanchez | Counselor | 2508 Sw 56th Street, Oklahoma City, OK 73119 | 2012-09-05 |
| 1720367493 | Hilarie Dawn Danner | Counselor | 2434 Sw 44 St., Oklahoma City, OK 73119 | 2011-08-11 |
| 1265630032 | Optics Inc Economy Square Optical | Technician/Technologist | 1605 Sw 59, Donnas Optical, Ok City, OK 73119 | 2007-07-03 |
| 1659441228 | Terrance Patrick Mcdermott | Family Medicine | 2536 Sw 29th Street, Mcdermott Clinic, Oklahoma City, OK 73119 | 2006-11-09 |
| 1336245679 | Christos Dimas | Internal Medicine | 2716 Sw 44th, Oklahoma City, OK 73119 | 2006-09-15 |
| 1073625299 | Nathan Dennis Schacter | Chiropractor | 2228 Sw 59th, Oklahoma City, OK 73119 | 2006-09-01 |
| 1548289655 | John Bernard Hughes Jr. | Orthopaedic Surgery | 2149 Southwest 59th Street, Suite 102, Oklahoma City, OK 73119 | 2006-07-19 |
| Find all providers in zip 73119 | ||||
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689029266 | Swalk Operations, LLC | Skilled Nursing Facility | 315 Sw 80th Street, Oklahoma City, OK 73139 | 2016-05-02 |
| 1376775957 | Manor Care of Oklahoma City (northwest) LLC | Skilled Nursing Facility | 5301 N Brookline Ave, Oklahoma City, OK 73112-3516 | 2009-08-17 |
| 1902030570 | City of Pauls Valley | Skilled Nursing Facility | 2333 Tuscany Blvd, Oklahoma City, OK 73120-3702 | 2009-05-11 |
| 1982885265 | Lutheran Senior Citizens, Inc | Skilled Nursing Facility | 7707 W Britton Rd, Oklahoma City, OK 73132-1512 | 2007-11-15 |
| 1124156153 | Bellecare Inc. | Skilled Nursing Facility | 2801 Nw 61st St, Oklahoma City, OK 73112-7007 | 2007-03-01 |
| 1376610972 | Windsor Hills Nursing Center, LLC | Skilled Nursing Facility | 2416 N Ann Arbor Ave, Oklahoma City, OK 73127-1811 | 2006-11-29 |
| 1407923824 | Warr Acres Nursing Center, LLC | Skilled Nursing Facility | 6501 N Macarthur Blvd, Oklahoma City, OK 73132-6505 | 2006-11-29 |
| 1851487508 | Edwards Redeemer Nursing Center, LLC | Skilled Nursing Facility | 1530 Ne Grand Blvd, Oklahoma City, OK 73117-5212 | 2006-10-04 |
| 1295830933 | Brookwood Nursing Center, LLC | Skilled Nursing Facility | 940 Sw 84th St, Oklahoma City, OK 73139-9255 | 2006-09-14 |
| 1164527727 | Sooner Geriatrics, LLC | Skilled Nursing Facility | 1913 Ne 50th St, Oklahoma City, OK 73111-7003 | 2006-09-14 |
| Find all providers in OKLAHOMA CITY | ||||
| City | OKLAHOMA CITY |
| Zip Code | 73119 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.