Provider Demographics
NPI:1992059398
Name:WOOD MANOR, INC.
Entity type:Organization
Organization Name:WOOD MANOR, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-283-4948
Mailing Address - Street 1:2700 NORTH HIICKORY STREET
Mailing Address - Street 2:P.O. BOX 1204
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74018
Mailing Address - Country:US
Mailing Address - Phone:918-283-4948
Mailing Address - Fax:918-283-4508
Practice Address - Street 1:2800 N. HICKORY
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017
Practice Address - Country:US
Practice Address - Phone:918-283-4948
Practice Address - Fax:918-283-4508
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WOOD MANOR, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH6609-6609311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)