# BROADWAY MANOR MANAGEMENT L.L.C

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Broadway Manor Nursing Home
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700885787
- **Authorized official:** MR. MICHAEL THORNTON SCOTT (MANAGING MEMBER)
- **Authorized official phone:** (918) 683-2851

## Contact information

- **Practice address:** 1622 E BROADWAY ST, MUSKOGEE, OK 74403-4601
- **Practice address phone:** (918) 683-2851
- **Practice address fax:** (918) 683-2992
- **Mailing address:** 1622 E BROADWAY ST, MUSKOGEE, OK 74403-4601
- **Mailing address phone:** (918) 683-2851
- **Mailing address fax:** (918) 683-2992

## Taxonomy

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

## Other

- **Enumeration date:** 07/20/2005
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000375146001 | BLUE CROSS BLUE SHIELD | OK |