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Organization
HENNESSEY MANOR NURSING HOME INC
Active
Organization
HENNESSEY 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
705 E 3RD ST, HENNESSEY, OK 73742-1620
(405) 853-6027
(405) 853-4389
Mailing address
705 E 3RD ST, HENNESSEY, OK 73742-1620
(405) 853-6027
(405) 853-4389
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
NH3703-3703
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200059260A
—
OK
01
—
731473404001
BLUE CROSS BLUE SHIELD OK
OK
Enumeration date
10/11/2005
Last updated
05/22/2008
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