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NPI Code Detail

MEDICARE: COLONIAL MANOR OPERATIONS LLC

MEDICARE: COLONIAL MANOR OPERATIONS LLC
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 Facility

General Provider Information

NPI Number : 1568259851
Entity Type Code : Organization
Provider Name (Legal Business Name) : COLONIAL MANOR OPERATIONS LLC
Provider Business Mailing Address
First Line : 1815 E SKELLY DR
Second Line :
City : TULSA
State : OK
Zip : 74105-5919
Country : US
Telephone Number :
Fax Number :
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 :
Authorized Official
Title or Position : LLC MANAGER
Name : DAVID GANZ
Credential :
Telephone Number : 832-422-8848
Provider Enumeration Date : 04/22/2025
Last Update Date : 04/22/2025

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Directions to “COLONIAL MANOR OPERATIONS LLC ” Practice Location

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