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General NPI Number Information
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NPI Number | 1346343720
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Entity Type | Organization
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Legal Business Name | SEQUOYAH MANOR LLC
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Dates
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Enumeration Date | 09/07/2006
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Last Update Date | 01/28/2008
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Provider Practice Location Address
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Address Line | 615 EAST REDWOOD
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City | SALLISAW
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State | OK
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Zip | 74955
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Country | US
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Telephone | 918-775-4881
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Fax | 918-775-2752
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Provider Business Mailing Address
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Address Line | 615 E. REDWOOD STREET
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City | SALLISAW
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State | OK
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Zip | 74955
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Country | US
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Telephone | 918-775-4881
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Fax | 918-775-2752
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. DEBBIE LYNN SANDERS
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Credential |
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Telephone | 918-775-4881
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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 | NH68036803
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License Number State | OK
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