Organization
MITCHELL MANOR CONVALESCENT HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NIVA JO MITCHELL (ADMINISTRATOR)
(918) 423-4661
Entity
Organization
Contact information
Practice address
315 W ELECTRIC AVE, MCALESTER, OK 74501-3600
(918) 423-4661
(918) 423-8382
Mailing address
315 W ELECTRIC AVE, MCALESTER, OK 74501-3600
(918) 423-4661
(918) 423-8382
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
NH6104-6104
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100774320A
—
OK
Enumeration date
02/07/2007
Last updated
07/15/2014
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