Organization
SULPHUR MANOR INC
Active
Other names
Callaway Nursing Home
Organization subpart
No
Provider details
NPI number
Authorized official
JANICE PITA (INSURANCE/MEDICARE)
(580) 622-6300
Entity
Organization
Contact information
Practice address
1300 W LINDSAY AVE, SULPHUR, OK 73086-6650
(580) 622-4600
(580) 622-5151
Mailing address
1300 W LINDSAY AVE, SULPHUR, OK 73086-6650
(580) 622-4600
(580) 622-5151
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
NH5003-5003
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000375401001
BLUE CROSS/BLUE SHIELD
OK
05
—
100776290A
—
OK
Enumeration date
10/04/2005
Last updated
06/16/2008
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