# COLONIAL PLAZA NURSING HOME INC

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

## Provider details

- **NPI number:** 1962503318
- **Authorized official:** ED RUCKER (ADMISTRATOR)
- **Authorized official phone:** (918) 743-7838

## Contact information

- **Practice address:** 530 S LINWOOD AVE, CUSHING, OK 74023-4644
- **Practice address phone:** (918) 743-7838
- **Mailing address:** 530 S LINWOOD AVE, CUSHING, OK 74023-4644
- **Mailing address phone:** (918) 743-7838

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | 0004362 | OK | Yes |
| 314000000X | Skilled Nursing Facility | 375471 | OK | — |

## Other

- **Enumeration date:** 09/26/2006
- **Last updated:** 07/15/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100771500A | — | OK |