Organization
GRAND UNION HEALTHCARE L.L.C,
Active
Other names
Monroe Manor
Organization subpart
No
Provider details
NPI number
Authorized official
ORRISE MATHESON (ADMINISTRATOR)
(918) 253-4500
Entity
Organization
Contact information
Practice address
226 EAST MONROE STREET, JAY, OK 74346-0409
(918) 253-4500
(918) 253-6064
Mailing address
PO BOX 409, JAY, OK 74346-0409
(918) 253-4500
(918) 253-6064
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100778240A
—
OK
Enumeration date
09/21/2006
Last updated
12/22/2011
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