Organization
LAKELAND MANOR INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY PORTER PH.D., J.D., D.PH. (PRESIDENT CEO)
(580) 490-9200
Entity
Organization
Contact information
Practice address
604 LAKE MURRAY DR E, ARDMORE, OK 73401-3851
(580) 223-4501
(580) 223-5002
Mailing address
PO BOX 128, ARDMORE, OK 73402-0128
(580) 490-9200
(580) 490-9201
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NH1005-1005
OK
Other
Enumeration date
09/28/2006
Last updated
08/22/2020
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