Organization
COLONIAL PARK MANOR, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONNA SIMMONS LNHA (MANAGING MEMBER)
(405) 380-6671
Entity
Organization
Contact information
Practice address
600 W. FRONTAGE ROAD, OKEMAH, OK 74859-6433
(918) 623-1936
(918) 623-1936
Mailing address
600 W FRONTAGE RD, OKEMAH, OK 74859-6442
(918) 623-1936
(918) 623-2287
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NH5405-5405
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200649070A
—
OK
Enumeration date
08/31/2015
Last updated
09/19/2025
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