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NPI Code Detail

MEDICARE: MANOR CARE OF OKLAHOMA CITY (NORTHWEST) LLC

MEDICARE: MANOR CARE OF OKLAHOMA CITY (NORTHWEST) LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing FacilityNH55135513OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1376775957
Entity Type Code : Organization
Provider Name (Legal Business Name) : MANOR CARE OF OKLAHOMA CITY (NORTHWEST) LLC
Provider Business Mailing Address
First Line : 333 N SUMMIT ST
Second Line : ATTN BARRY LAZARUS
City : TOLEDO
State : OH
Zip : 43604-1531
Country : US
Telephone Number : 419-252-5541
Fax Number : 419-254-5494
Provider Business Practice Location Address
First Line : 5301 N BROOKLINE AVE
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73112-3516
Country : US
Telephone Number : 405-946-3351
Fax Number : 405-948-6132
Authorized Official
Title or Position : VICE PRESIDENT - REIMBURSEMENT
Name : MR. BARRY A LAZARUS
Credential :
Telephone Number : 419-252-5541
Provider Enumeration Date : 08/17/2009
Last Update Date : 12/22/2009

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