Organization
OAK GROVE MANOR, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DEWEY DEWAYNE PEBWORTH (ADMINISTRATOR)
(580) 286-2537
Entity
Organization
Contact information
Practice address
HIGHWAY 259 SOUTH, IDABEL, OK 74745
(580) 286-2537
Mailing address
PO BOX 299, IDABEL, OK 74745-0299
(580) 286-2537
(580) 286-5480
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
NH4505-4505
OK
314000000X
Skilled Nursing Facility
Primary
NH4505-4505
OK
Other
Enumeration date
10/19/2005
Last updated
02/25/2008
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