Organization
OPCO COWETA, OK, LLC
Active
Other names
Coweta Manor Nursing Home
Organization subpart
No
Provider details
NPI number
Authorized official
ISAAC DOLE (MANAGER)
(773) 645-9246
Entity
Organization
Contact information
Practice address
30049 E 151ST ST S, COWETA, OK 74429-4544
(918) 486-2166
Mailing address
2045 W GRAND AVE STE B34572, CHICAGO, IL 60612-1576
(312) 724-8950
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Enumeration date
01/15/2021
Last updated
10/29/2024
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