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General NPI Number Information
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NPI Number | 1780322420
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Entity Type | Organization
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Legal Business Name | DARLENE INVESTMENT GROUP LAKELAND MANOR, INC.
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Dates
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Enumeration Date | 05/23/2022
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Last Update Date | 09/15/2022
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Provider Practice Location Address
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Address Line | 604 LAKE MURRAY DR E
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City | ARDMORE
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State | OK
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Zip | 73401-3851
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Country | US
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Telephone | 580-513-0280
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Fax | 469-680-5842
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Provider Business Mailing Address
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Address Line | 1405 4TH AVE NW # 265
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City | ARDMORE
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State | OK
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Zip | 73401-2708
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Country | US
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Telephone | 580-513-0280
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Fax | 469-680-5842
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Authorized Official
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Title or Position | VICE PRESIDENT/TREASURER & DIRECTOR
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Name | MS. AMY CLANTON
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Credential |
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Telephone | 580-513-0280
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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 |
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License Number State |
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