Provider Demographics
NPI:1376775957
Name:MANOR CARE OF OKLAHOMA CITY (NORTHWEST) LLC
Entity Type:Organization
Organization Name:MANOR CARE OF OKLAHOMA CITY (NORTHWEST) LLC
Other - Org Name:MANORCARE HEALTH SERVICES - NORTHWEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT - REIMBURSEMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAZARUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-252-5541
Mailing Address - Street 1:333 N SUMMIT ST
Mailing Address - Street 2:ATTN BARRY LAZARUS
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1531
Mailing Address - Country:US
Mailing Address - Phone:419-252-5541
Mailing Address - Fax:419-254-5494
Practice Address - Street 1:5301 N BROOKLINE AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-3516
Practice Address - Country:US
Practice Address - Phone:405-946-3351
Practice Address - Fax:405-948-6132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-17
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH55135513314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200264150AMedicaid
OK200264150AMedicaid