Grand Union Healthcare L.L.C,

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

GRAND UNION HEALTHCARE L.L.C,

Doing business as

Monroe Manor

Practice address

226 East Monroe Street
Jay, OK 74346-0409

Phone

(918) 253-4500

Fax

(918) 253-6064

NPI assigned

Sep 21, 2006

Last updated

Dec 22, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Orrise Matheson

Title

Administrator

Phone

(918) 253-4500

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Monroe Manor Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1324512000000",
    "number": "1013016864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 409",
            "city": "JAY",
            "state": "OK",
            "postal_code": "743460409",
            "telephone_number": "918-253-4500",
            "fax_number": "918-253-6064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "226 EAST MONROE STREET",
            "city": "JAY",
            "state": "OK",
            "postal_code": "743460409",
            "telephone_number": "918-253-4500",
            "fax_number": "918-253-6064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND UNION HEALTHCARE L.L.C,",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-21",
        "last_updated": "2011-12-22",
        "status": "A",
        "authorized_official_last_name": "MATHESON",
        "authorized_official_first_name": "ORRISE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "918-253-4500"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100778240A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Monroe Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Grand Lake Mental Health Center, Inc. (GRAND Mental Health)
• Grand Lake Mental Health Center, Inc. (GRAND Mental Health)
• Grand Lake Mental Health Center, Inc. (GRAND Mental Health)
• Grand Lake Mental Health Center, Inc. (GRAND Mental Health)
• Grand Union Healthcare (Monroe Manor)
• Lou Ann Graves
• Margaret Ann Grayson, D.D.S.
• Ty Julian Gregson
• Abby Ann Hacker, DMD
• Stefan Shane Hacker, DDS

• Skilled Nursing Facility in Jay, OK
• Providers in Jay, OK by specialty
• Skilled Nursing Facility in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.