Healthcare Provider Details

I. General information

NPI: 1780322420
Provider Name (Legal Business Name): DARLENE INVESTMENT GROUP LAKELAND MANOR, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2022
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 LAKE MURRAY DR E
ARDMORE OK
73401-3851
US

IV. Provider business mailing address

1405 4TH AVE NW # 265
ARDMORE OK
73401-2708
US

V. Phone/Fax

Practice location:
  • Phone: 580-513-0280
  • Fax: 469-680-5842
Mailing address:
  • Phone: 580-513-0280
  • Fax: 469-680-5842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. AMY CLANTON
Title or Position: VICE PRESIDENT/TREASURER & DIRECTOR
Credential:
Phone: 580-513-0280