Organization
EASTWOOD MANOR, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEVIN DOUGLAS MORAN (BUSINESS MANAGEMENT)
(918) 775-4439
Entity
Organization
Contact information
Practice address
519 N MICKEY MANTLE BLVD, COMMERCE, OK 74339-1127
(918) 675-4455
(918) 675-5472
Mailing address
PO BOX 429, SALLISAW, OK 74955-0429
(918) 775-4439
(918) 775-9242
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
NH5802-5802
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200081000A
—
OK
Enumeration date
09/25/2006
Last updated
07/16/2008
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