# OK4 BROADWAY OPCO LLC

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

## Provider details

- **NPI number:** 1952758294
- **Authorized official:** ISAAC DOLE (MANAGER/PRINCIPAL)
- **Authorized official phone:** (773) 645-9246

## Contact information

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

## Taxonomy

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

## Other

- **Enumeration date:** 05/17/2016
- **Last updated:** 10/29/2024