# OAK GROVE MANOR, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1891784070
- **Authorized official:** MR. DEWEY DEWAYNE PEBWORTH (ADMINISTRATOR)
- **Authorized official phone:** (580) 286-2537

## Contact information

- **Practice address:** HIGHWAY 259 SOUTH, IDABEL, OK 74745
- **Practice address phone:** (580) 286-2537
- **Mailing address:** PO BOX 299, IDABEL, OK 74745-0299
- **Mailing address phone:** (580) 286-2537
- **Mailing address fax:** (580) 286-5480

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | NH4505-4505 | OK | — |
| 314000000X | Skilled Nursing Facility | NH4505-4505 | OK | Yes |

## Other

- **Enumeration date:** 10/19/2005
- **Last updated:** 02/25/2008