Provider Demographics
NPI:1144387259
Name:ROSE MANOR, LLC
Entity Type:Organization
Organization Name:ROSE MANOR, LLC
Other - Org Name:ROSE MANOR NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:JEANNE
Authorized Official - Last Name:PRAYTOR
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:405-598-5613
Mailing Address - Street 1:1610 NORTH BRYAN
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-4229
Mailing Address - Country:US
Mailing Address - Phone:405-275-9004
Mailing Address - Fax:405-275-9472
Practice Address - Street 1:1610 NORTH BRYAN
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-4229
Practice Address - Country:US
Practice Address - Phone:405-275-9004
Practice Address - Fax:405-275-9472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH6301-6301313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK375508Medicare Oscar/Certification