Healthcare Provider Details

I. General information

NPI: 1922095009
Provider Name (Legal Business Name): ANTLERS MANOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 03/18/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 E MAIN ST
ANTLERS OK
74523-3217
US

IV. Provider business mailing address

511 E MAIN ST
ANTLERS OK
74523-3217
US

V. Phone/Fax

Practice location:
  • Phone: 580-298-3294
  • Fax: 580-298-5885
Mailing address:
  • Phone: 580-298-3294
  • Fax: 580-298-5885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH-6401
License Number StateOK

VIII. Authorized Official

Name: MICHAEL BRANDON MORGAN
Title or Position: PRESIDENT
Credential:
Phone: 479-769-5535