Healthcare Provider Details

I. General information

NPI: 1386876969
Provider Name (Legal Business Name): MANOR CARE OF TULSA OK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2009
Last Update Date: 12/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 S MEMORIAL DR
TULSA OK
74129-2617
US

IV. Provider business mailing address

333 N SUMMIT ST ATTN BARRY LAZARUS
TOLEDO OH
43604-1531
US

V. Phone/Fax

Practice location:
  • Phone: 918-628-0932
  • Fax: 918-622-2060
Mailing address:
  • Phone: 419-252-5541
  • Fax: 419-254-5494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH72107210
License Number StateOK

VIII. Authorized Official

Name: MR. BARRY A LAZARUS
Title or Position: VICE PRESIDENT - REIMBURSEMENT
Credential:
Phone: 419-252-5541