# MCALESTER MANOR INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Legacy Living Centers
- **Organization subpart:** No

## Provider details

- **NPI number:** 1811984891
- **Authorized official:** JANICE PITA (INSURANCE/MEDICARE)
- **Authorized official phone:** (580) 622-6300

## Contact information

- **Practice address:** 615 E MORRIS AVE, MCALESTER, OK 74501-3159
- **Practice address phone:** (918) 426-4010
- **Practice address fax:** (918) 426-4820
- **Mailing address:** 615 E MORRIS AVE, MCALESTER, OK 74501-3159
- **Mailing address phone:** (918) 426-4010
- **Mailing address fax:** (918) 426-4820

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | NH6107-6107 | OK | Yes |

## Other

- **Enumeration date:** 10/04/2005
- **Last updated:** 05/22/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000375487001 | BLUE CROSS BLUE SHIELD | OK |
| 05 | — | 200059450A | — | OK |