Healthcare Provider Details

I. General information

NPI: 1407844533
Provider Name (Legal Business Name): MARLOW MANOR NURSING HOME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 S 9TH ST
MARLOW OK
73055-3226
US

IV. Provider business mailing address

702 S 9TH ST
MARLOW OK
73055-3226
US

V. Phone/Fax

Practice location:
  • Phone: 580-658-5468
  • Fax: 580-658-3669
Mailing address:
  • Phone: 580-658-5468
  • Fax: 580-658-3669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License NumberNH6907-6907
License Number StateOK

VIII. Authorized Official

Name: JANICE PITA
Title or Position: INSURANCE/MEDICARE
Credential:
Phone: 580-622-6300