# COLONIAL PLAZA MANAGEMENT COMPANY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Linwood Village Nursing and Retirement
- **Organization subpart:** No

## Provider details

- **NPI number:** 1750423661
- **Authorized official:** MR. BOB G POPE C.O.O (MEMBER)
- **Authorized official phone:** (918) 743-7838

## Contact information

- **Practice address:** 530 S LINWOOD AVE, CUSHING, OK 74023-4644
- **Practice address phone:** (918) 225-2220
- **Practice address fax:** (918) 225-4447
- **Mailing address:** 530 S LINWOOD AVE, CUSHING, OK 74023-4644
- **Mailing address phone:** (918) 743-7838
- **Mailing address fax:** (918) 748-5970

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | NH6001-6001 | OK | Yes |

## Other

- **Enumeration date:** 02/14/2007
- **Last updated:** 12/02/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 20119150A | — | OK |