# COLONIAL PARK NURSING HOME INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** COLONIAL PARK NURSING HOME
- **Organization subpart:** No

## Provider details

- **NPI number:** 1467750976
- **Authorized official:** MR. JOHN SMART (PRESIDENT)
- **Authorized official phone:** (405) 380-6902

## Contact information

- **Practice address:** 600 W FRONTAGE RD, OKEMAH, OK 74859-6433
- **Practice address phone:** (918) 623-1936
- **Practice address fax:** (918) 623-2287
- **Mailing address:** 131 N BROADWAY AVE, ADA, OK 74820-5003
- **Mailing address phone:** (580) 436-0950
- **Mailing address fax:** (580) 436-0953

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | NH5405-5405 | OK | — |
| 314000000X | Skilled Nursing Facility | NH5405-5405 | OK | Yes |

## Other

- **Enumeration date:** 03/08/2011
- **Last updated:** 03/08/2011