Healthcare Provider Details

I. General information

NPI: 1992059398
Provider Name (Legal Business Name): WOOD MANOR, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2012
Last Update Date: 11/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 N. HICKORY
CLAREMORE OK
74017
US

IV. Provider business mailing address

2700 NORTH HIICKORY STREET P.O. BOX 1204
CLAREMORE OK
74018
US

V. Phone/Fax

Practice location:
  • Phone: 918-283-4948
  • Fax: 918-283-4508
Mailing address:
  • Phone: 918-283-4948
  • Fax: 918-283-4508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License NumberNH6609-6609
License Number StateOK

VIII. Authorized Official

Name: MR. MATTHEW SNYDER
Title or Position: ADMINISTRATOR
Credential:
Phone: 918-283-4948