Organization
OK4 BROADWAY OPCO LLC
Active
Other names
Broadway Manor Nursing Home
Organization subpart
No
Provider details
NPI number
Authorized official
ISAAC DOLE (MANAGER/PRINCIPAL)
(773) 645-9246
Entity
Organization
Contact information
Practice address
1622 E BROADWAY ST, MUSKOGEE, OK 74403-4601
(918) 683-2851
Mailing address
1622 E BROADWAY ST, MUSKOGEE, OK 74403-4601
(918) 683-2851
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
OK
Other
Enumeration date
05/17/2016
Last updated
10/29/2024
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