# COLONIAL MANOR NURSING CENTER, INC.

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

## Provider details

- **NPI number:** 1124129556
- **Authorized official:** MR. ED RUCKER (ADMINISTRATOR)
- **Authorized official phone:** (918) 743-7838

## Contact information

- **Practice address:** 1815 E SKELLY DR, TULSA, OK 74105-5919
- **Practice address phone:** (918) 743-7838
- **Mailing address:** 1815 E SKELLY DR, TULSA, OK 74105-5919
- **Mailing address phone:** (918) 743-7838

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | NH7208-7208 | OK | — |
| 314000000X | Skilled Nursing Facility | 375465 | OK | Yes |

## Other

- **Enumeration date:** 09/26/2006
- **Last updated:** 09/11/2025