Provider Demographics
NPI:1023007770
Name:OAK MANOR NURSING AND REHABILITATION CENTER INC
Entity Type:Organization
Organization Name:OAK MANOR NURSING AND REHABILITATION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:MORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-783-4672
Mailing Address - Street 1:415 ROGERS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-1903
Mailing Address - Country:US
Mailing Address - Phone:479-783-4672
Mailing Address - Fax:479-783-2217
Practice Address - Street 1:150 MORTON AVENUE
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72927
Practice Address - Country:US
Practice Address - Phone:479-675-3763
Practice Address - Fax:479-675-2943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR817314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR045301Medicare Oscar/Certification