Provider Demographics
NPI:1780322420
Name:DARLENE INVESTMENT GROUP LAKELAND MANOR, INC.
Entity type:Organization
Organization Name:DARLENE INVESTMENT GROUP LAKELAND MANOR, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/TREASURER & DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-513-0280
Mailing Address - Street 1:1405 4TH AVE NW # 265
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-2708
Mailing Address - Country:US
Mailing Address - Phone:580-513-0280
Mailing Address - Fax:469-680-5842
Practice Address - Street 1:604 LAKE MURRAY DR E
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-3851
Practice Address - Country:US
Practice Address - Phone:580-513-0280
Practice Address - Fax:469-680-5842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-23
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility