Organization
COLONIAL MANOR MANAGEMENT COMPANY, L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ED RUCKER (ADMINISTRATOR)
(918) 743-7838
Entity
Organization
Contact information
Practice address
1815 E SKELLY DR, TULSA, OK 74105-5919
(918) 743-7838
(918) 748-5970
Mailing address
1815 E SKELLY DR, TULSA, OK 74105-5919
(918) 743-7838
(918) 748-5970
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NH7208-7208
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200119130A
—
OK
Enumeration date
02/13/2007
Last updated
05/18/2011
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