# LAKELAND MANOR INC

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

## Provider details

- **NPI number:** 1578655817
- **Authorized official:** DR. GARY PORTER PH.D., J.D., D.PH. (PRESIDENT CEO)
- **Authorized official phone:** (580) 490-9200

## Contact information

- **Practice address:** 604 LAKE MURRAY DR E, ARDMORE, OK 73401-3851
- **Practice address phone:** (580) 223-4501
- **Practice address fax:** (580) 223-5002
- **Mailing address:** PO BOX 128, ARDMORE, OK 73402-0128
- **Mailing address phone:** (580) 490-9200
- **Mailing address fax:** (580) 490-9201

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | NH1005-1005 | OK | Yes |

## Other

- **Enumeration date:** 09/28/2006
- **Last updated:** 08/22/2020