Organization Active NPI

Colonial Manor Nursing Center, Inc.

  • Skilled Nursing Facility
  • Tulsa, OK
National Provider Identifier
1124129556
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
375465 Issued in OK
Legal business name
COLONIAL MANOR NURSING CENTER, INC.
Practice address
1815 E Skelly Dr
Tulsa, OK 74105-5919
Phone
(918) 743-7838
NPI assigned
Sep 26, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Authorized official

Name
Mr. Ed Rucker
Title
Administrator
Phone
(918) 743-7838

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X NH7208-7208 OK
Skilled Nursing Facility 314000000X 375465 OK Primary

Addresses

Primary practice location

1815 E Skelly Dr
Tulsa, OK 74105-5919

Mailing address

1815 E Skelly Dr
Tulsa, OK 74105-5919
Phone (918) 743-7838

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1124129556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1815 E SKELLY DR",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741055919",
            "telephone_number": "918-743-7838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1815 E SKELLY DR",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741055919",
            "telephone_number": "918-743-7838"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLONIAL MANOR NURSING CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-26",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "RUCKER",
        "authorized_official_first_name": "ED",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "918-743-7838",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "OK",
            "license": "NH7208-7208",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OK",
            "license": "375465",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.