Healthcare Provider Details

I. General information

NPI: 1720799653
Provider Name (Legal Business Name): MONROE MANOR NURSING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 E MONROE AVE
JAY OK
74346-2914
US

IV. Provider business mailing address

226 E MONROE AVE
JAY OK
74346-2914
US

V. Phone/Fax

Practice location:
  • Phone: 918-919-3276
  • Fax: 918-544-6155
Mailing address:
  • Phone: 918-919-3276
  • Fax: 918-544-6155

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: ZVI RHINE
Title or Position: MEMBER
Credential:
Phone: 918-919-3276