Organization
MARLOW MANOR NURSING HOME INC
Active
Other names
Legacy Living Centers
Organization subpart
No
Provider details
NPI number
Authorized official
JANICE PITA (INSURANCE/MEDICARE)
(580) 622-6300
Entity
Organization
Contact information
Practice address
702 S 9TH ST, MARLOW, OK 73055-3226
(580) 658-5468
(580) 658-3669
Mailing address
702 S 9TH ST, MARLOW, OK 73055-3226
(580) 658-5468
(580) 658-3669
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
NH6907-6907
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000375490001
BLUE CROSS BLUE SHIELD OK
OK
05
—
200055070A
—
OK
Enumeration date
10/12/2005
Last updated
06/16/2008
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