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General NPI Number Information
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NPI Number | 1134306335
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Entity Type | Organization
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Legal Business Name | ATOKA MANOR INC
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Dates
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Enumeration Date | 01/30/2008
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Last Update Date | 03/12/2012
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Provider Practice Location Address
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Address Line | 1500 S VIRGINIA AVE
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City | ATOKA
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State | OK
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Zip | 74525-3246
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Country | US
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Telephone | 580-889-2500
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Fax | 580-889-2888
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Provider Business Mailing Address
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Address Line | 1500 S VIRGINIA AVE
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City | ATOKA
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State | OK
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Zip | 74525-3246
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Country | US
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Telephone | 580-889-2500
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Fax | 580-889-2888
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Authorized Official
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Title or Position | CHAIR PERSON
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Name | MS. TRACI DIANN WALKER
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Credential |
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Telephone | 580-364-2286
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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 | NH0302-0302
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License Number State | OK
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