Healthcare Provider Details

I. General information

NPI: 1659445377
Provider Name (Legal Business Name): BIXBY MANOR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 01/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 W RACHEL ST
BIXBY OK
74008-4908
US

IV. Provider business mailing address

PO BOX 670
BIXBY OK
74008-0670
US

V. Phone/Fax

Practice location:
  • Phone: 918-366-4491
  • Fax: 918-366-6220
Mailing address:
  • Phone: 918-366-4492
  • Fax: 918-366-6220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH7203-7203
License Number StateOK

VIII. Authorized Official

Name: MR. WAYNE WOOD
Title or Position: OWNER
Credential:
Phone: 918-366-4492