Provider Demographics
NPI:1669460507
Name:DUNCAN MANOR INC
Entity Type:Organization
Organization Name:DUNCAN MANOR INC
Other - Org Name:DUNCAN CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE/MEDICARE
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:PITA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-622-6300
Mailing Address - Street 1:700 PALM DR
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-3324
Mailing Address - Country:US
Mailing Address - Phone:580-522-9000
Mailing Address - Fax:580-255-0565
Practice Address - Street 1:700 PALM DR
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-3324
Practice Address - Country:US
Practice Address - Phone:580-522-9000
Practice Address - Fax:580-255-0565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-13
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH6902-6902313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200059960AMedicaid
OK000375484001OtherBLUE CROSS BLUE SHIELD OK
OK375484Medicare ID - Type UnspecifiedMEDICARE OKLAHOMA