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NPI Code Detail

MEDICARE: COLONIAL MANOR MANAGEMENT COMPANY, L.L.C.

MEDICARE: COLONIAL MANOR MANAGEMENT COMPANY, L.L.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing FacilityNH7208-7208OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1225170467
Entity Type Code : Organization
Provider Name (Legal Business Name) : COLONIAL MANOR MANAGEMENT COMPANY, L.L.C.
Provider Business Mailing Address
First Line : 1815 E SKELLY DR
Second Line :
City : TULSA
State : OK
Zip : 74105-5919
Country : US
Telephone Number : 918-743-7838
Fax Number : 918-748-5970
Provider Business Practice Location Address
First Line : 1815 E SKELLY DR
Second Line :
City : TULSA
State : OK
Zip : 74105-5919
Country : US
Telephone Number : 918-743-7838
Fax Number : 918-748-5970
Authorized Official
Title or Position : ADMINISTRATOR
Name : MR. ED RUCKER
Credential :
Telephone Number : 918-743-7838
Provider Enumeration Date : 02/13/2007
Last Update Date : 05/18/2011

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