Provider Demographics
NPI:1942366810
Name:THE ATOKA GROUP, LLC
Entity Type:Organization
Organization Name:THE ATOKA GROUP, LLC
Other - Org Name:ATOKA COLONIAL MANOR NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:POWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-534-8667
Mailing Address - Street 1:1901 RICKETY LN
Mailing Address - Street 2:STE 208
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-1702
Mailing Address - Country:US
Mailing Address - Phone:903-534-8667
Mailing Address - Fax:903-509-0026
Practice Address - Street 1:1500 S VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:ATOKA
Practice Address - State:OK
Practice Address - Zip Code:74525-3246
Practice Address - Country:US
Practice Address - Phone:580-889-2500
Practice Address - Fax:580-889-2888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH0302-0302313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK20038500AMedicaid