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Organization
BROADWAY MANOR MANAGEMENT L.L.C
Active
Organization
BROADWAY MANOR MANAGEMENT L.L.C
Active
Other names
Broadway Manor Nursing Home
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL THORNTON SCOTT (MANAGING MEMBER)
(918) 683-2851
Entity
Organization
Contact information
Practice address
1622 E BROADWAY ST, MUSKOGEE, OK 74403-4601
(918) 683-2851
(918) 683-2992
Mailing address
1622 E BROADWAY ST, MUSKOGEE, OK 74403-4601
(918) 683-2851
(918) 683-2992
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000375146001
BLUE CROSS BLUE SHIELD
OK
Enumeration date
07/20/2005
Last updated
08/22/2020
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