Organization
BROADWAY MANOR MANAGEMENT L.L.C
Active
Other names
Broadway Manor Nursing Home
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL THORNTON SCOTT (MANAGING MEMBER)
(918) 683-2851
Entity
Organization
Contact information
Practice address
1622 E BROADWAY ST, MUSKOGEE, OK 74403-4601
(918) 683-2851
(918) 683-2992
Mailing address
1622 E BROADWAY ST, MUSKOGEE, OK 74403-4601
(918) 683-2851
(918) 683-2992
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000375146001
BLUE CROSS BLUE SHIELD
OK
Enumeration date
07/20/2005
Last updated
08/22/2020
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