Organization
MCALESTER MANOR INC
Active
Other names
Legacy Living Centers
Organization subpart
No
Provider details
NPI number
Authorized official
JANICE PITA (INSURANCE/MEDICARE)
(580) 622-6300
Entity
Organization
Contact information
Practice address
615 E MORRIS AVE, MCALESTER, OK 74501-3159
(918) 426-4010
(918) 426-4820
Mailing address
615 E MORRIS AVE, MCALESTER, OK 74501-3159
(918) 426-4010
(918) 426-4820
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
NH6107-6107
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000375487001
BLUE CROSS BLUE SHIELD
OK
05
—
200059450A
—
OK
Enumeration date
10/04/2005
Last updated
05/22/2008
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