# COLONIAL PARK MANOR, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033586664
- **Authorized official:** DONNA SIMMONS LNHA (MANAGING MEMBER)
- **Authorized official phone:** (405) 380-6671

## Contact information

- **Practice address:** 600 W. FRONTAGE ROAD, OKEMAH, OK 74859-6433
- **Practice address phone:** (918) 623-1936
- **Practice address fax:** (918) 623-1936
- **Mailing address:** 600 W FRONTAGE RD, OKEMAH, OK 74859-6442
- **Mailing address phone:** (918) 623-1936
- **Mailing address fax:** (918) 623-2287

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | NH5405-5405 | OK | Yes |

## Other

- **Enumeration date:** 08/31/2015
- **Last updated:** 09/19/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200649070A | — | OK |