Provider Demographics
NPI:1437379096
Name:SWEET TOWN LLC
Entity Type:Organization
Organization Name:SWEET TOWN LLC
Other - Org Name:CLEVELAND MANOR NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-776-0033
Mailing Address - Street 1:900 N DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OK
Mailing Address - Zip Code:74020-1222
Mailing Address - Country:US
Mailing Address - Phone:918-358-3135
Mailing Address - Fax:918-358-5536
Practice Address - Street 1:100 E CHOCTAW AVE
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955-4607
Practice Address - Country:US
Practice Address - Phone:918-776-0033
Practice Address - Fax:918-776-0880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH5901-5901313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK375443Medicare ID - Type Unspecified