# HEAVENER MANOR, LLC

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

## Provider details

- **NPI number:** 1174941496
- **Authorized official:** BRADFORD MONTGOMERY (MEMBER)
- **Authorized official phone:** (479) 250-5558

## Contact information

- **Practice address:** 204 W 1ST ST, HEAVENER, OK 74937-2062
- **Practice address phone:** (918) 653-2034
- **Practice address fax:** (918) 653-4518
- **Mailing address:** 9 PROFESSIONAL DR, BELLA VISTA, AR 72715-8462
- **Mailing address phone:** (479) 259-5558

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | NH4001-4001 | OK | Yes |

## Other

- **Enumeration date:** 04/03/2014
- **Last updated:** 06/07/2024