Provider Demographics
NPI:1134306335
Name:ATOKA MANOR INC
Entity Type:Organization
Organization Name:ATOKA MANOR INC
Other - Org Name:D/B/A ATOKA MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIR PERSON
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:DIANN
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-364-2286
Mailing Address - Street 1:1500 S VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:ATOKA
Mailing Address - State:OK
Mailing Address - Zip Code:74525-3246
Mailing Address - Country:US
Mailing Address - Phone:580-889-2500
Mailing Address - Fax:580-889-2888
Practice Address - Street 1:1500 S VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:ATOKA
Practice Address - State:OK
Practice Address - Zip Code:74525-3246
Practice Address - Country:US
Practice Address - Phone:580-889-2500
Practice Address - Fax:580-889-2888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-30
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH0302-0302314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility