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General NPI Number Information
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NPI Number | 1992059398
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Entity Type | Organization
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Legal Business Name | WOOD MANOR, INC.
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Dates
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Enumeration Date | 11/07/2012
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Last Update Date | 11/07/2012
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Provider Practice Location Address
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Address Line | 2800 N. HICKORY
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City | CLAREMORE
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State | OK
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Zip | 74017
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Country | US
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Telephone | 918-283-4948
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Fax | 918-283-4508
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Provider Business Mailing Address
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Address Line | 2700 NORTH HIICKORY STREET P.O. BOX 1204
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City | CLAREMORE
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State | OK
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Zip | 74018
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Country | US
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Telephone | 918-283-4948
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Fax | 918-283-4508
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. MATTHEW SNYDER
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Credential |
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Telephone | 918-283-4948
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311500000X
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Taxonomy Name | Alzheimer Center (Dementia Center)
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License Number | NH6609-6609
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License Number State | OK
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