Provider Demographics
NPI:1164461570
Name:SHAWN MANOR NURSING HOME
Entity Type:Organization
Organization Name:SHAWN MANOR NURSING HOME
Other - Org Name:HNMS, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:QUALITY ASSURANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:HS
Authorized Official - Phone:580-765-3364
Mailing Address - Street 1:2024 TURNER ROAD
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74604-2732
Mailing Address - Country:US
Mailing Address - Phone:580-765-3364
Mailing Address - Fax:580-765-3376
Practice Address - Street 1:2024 TURNER ROAD
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74604-2732
Practice Address - Country:US
Practice Address - Phone:580-765-3364
Practice Address - Fax:580-765-3376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH3607-3607313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK375194Medicare Oscar/Certification