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Organization
MARLOW MANOR NURSING HOME INC
Active
Organization
MARLOW MANOR NURSING HOME INC
Active
Other names
Legacy Living Centers
Organization subpart
No
Provider details
NPI number
Authorized official
JANICE PITA (INSURANCE/MEDICARE)
(580) 622-6300
Entity
Organization
Contact information
Practice address
702 S 9TH ST, MARLOW, OK 73055-3226
(580) 658-5468
(580) 658-3669
Mailing address
702 S 9TH ST, MARLOW, OK 73055-3226
(580) 658-5468
(580) 658-3669
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
NH6907-6907
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000375490001
BLUE CROSS BLUE SHIELD OK
OK
05
—
200055070A
—
OK
Enumeration date
10/12/2005
Last updated
06/16/2008
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