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General NPI Number Information
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NPI Number | 1033586664
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Entity Type | Organization
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Legal Business Name | COLONIAL PARK MANOR, LLC
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Dates
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Enumeration Date | 08/31/2015
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 600 W. FRONTAGE ROAD
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City | OKEMAH
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State | OK
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Zip | 74859-6433
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Country | US
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Telephone | 918-623-1936
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Fax | 918-623-1936
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Provider Business Mailing Address
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Address Line | 600 W FRONTAGE RD
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City | OKEMAH
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State | OK
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Zip | 74859-6442
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Country | US
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Telephone | 918-623-1936
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Fax | 918-623-2287
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DONNA SIMMONS
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Credential | LNHA
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Telephone | 405-380-6671
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | NH5405-5405
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License Number State | OK
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