# COLONIAL TERRACE NURSING CARE CENTER LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Colonial Terrace Care Ctr
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669469755
- **Authorized official:** MS. SANDRA TAYLOR (VP IN CHARGE OF REIMBURSEMENT)
- **Authorized official phone:** (918) 775-6200

## Contact information

- **Practice address:** 1320 NE 1ST PL, PRYOR, OK 74361-4406
- **Practice address phone:** (918) 825-5311
- **Practice address fax:** (918) 825-4439
- **Mailing address:** 201 N ELM ST, SUITE A, SALLISAW, OK 74955-4633
- **Mailing address phone:** (918) 775-6200
- **Mailing address fax:** (918) 775-5643

## Taxonomy

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

## Other

- **Enumeration date:** 10/04/2005
- **Last updated:** 09/19/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100777360A | — | OK |