Organization
FAIRFAX MANOR LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JUSTIN MCGREW (BUSINESS MANAGEMENT)
(918) 775-4439
Entity
Organization
Contact information
Practice address
210 EAST CHOCTAW STREET, SALLISAW, OK 74955-0429
(918) 775-4439
(918) 775-9242
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
NH5702-5702
OK
Other
Enumeration date
10/05/2006
Last updated
08/24/2007
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