# FAIRFAX MANOR LLC

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

## Provider details

- **NPI number:** 1497841324
- **Authorized official:** MR. JUSTIN MCGREW (BUSINESS MANAGEMENT)
- **Authorized official phone:** (918) 775-4439

## Contact information

- **Practice address:** 210 EAST CHOCTAW STREET, SALLISAW, OK 74955-0429
- **Practice address phone:** (918) 775-4439
- **Practice address fax:** (918) 775-9242
- **Mailing address:** PO BOX 429, SALLISAW, OK 74955-0429
- **Mailing address phone:** (918) 775-4439
- **Mailing address fax:** (918) 775-9242

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | NH5702-5702 | OK | Yes |

## Other

- **Enumeration date:** 10/05/2006
- **Last updated:** 08/24/2007