Elmwood Manor Nursing Home LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

NH6701-6701 Issued in OK

Legal business name

ELMWOOD MANOR NURSING HOME LLC

Practice address

300 S Seminole Ave
Wewoka, OK 74884-2557

Phone

(405) 257-6621

Fax

(405) 257-6402

NPI assigned

Jul 28, 2005

Organization subpart

No

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

Authorized official

Name

Pam Humphreys

Title

Owner

Phone

(405) 379-0039

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• ELMWOOD MANOR NURSING HOME Doing business as

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Skilled nursing facility certification: CCN 375423

Legal name

ELMWOOD MANOR NURSING HOME LLC

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Jan 14, 2003

Last certification

Oct 24, 2024

Beds

46

Ownership / control type

Limited Liability Corporation

Organization structure

LLCProprietary

Enrollment address

300 S Seminole Ave
Wewoka, OK 74884-2557

Nursing home name

ELMWOOD MANOR NURSING HOME

Listed as

Elmwood Manor Nursing HomeCCN 375423

Overall star rating

1 of 5

Health inspections

1 of 5

Staffing

4 of 5

Quality measures

3 of 5

Type

Medicare and Medicaid

Ownership

For profit - Limited Liability company

Certified

Jan 14, 2003

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

4636.4 residents per day on average

Abuse citation

Cited for abuse (Care Compare abuse icon)

Penalties (3 years)

2Fines totaling $34,125

Processed by Care Compare on Aug 1, 2026.

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Heidi L Haislip, M.D.

  • Family Medicine Physician
  • Wewoka, OK
  • NPI 1336447135
  NPD (past)
• Terry Hermance, MD

  • Family Medicine Physician
  • Oklahoma City, OK
  • NPI 1518980580
  NPD (past)

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Heidi L Haislip, M.D.

  • Family Medicine Physician
  • Wewoka, OK
  • NPI 1336447135

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1122508800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736121600000",
    "number": "1225038524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 975",
            "city": "WEWOKA",
            "state": "OK",
            "postal_code": "748840975",
            "telephone_number": "405-257-6621",
            "fax_number": "405-257-6402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 S SEMINOLE AVE",
            "city": "WEWOKA",
            "state": "OK",
            "postal_code": "748842557",
            "telephone_number": "405-257-6621",
            "fax_number": "405-257-6402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELMWOOD MANOR NURSING HOME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-28",
        "last_updated": "2025-01-06",
        "certification_date": "2025-01-06",
        "status": "A",
        "authorized_official_last_name": "HUMPHREYS",
        "authorized_official_first_name": "PAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "405-379-0039"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OK",
            "license": "NH6701-6701",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200047510A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ELMWOOD MANOR NURSING HOME",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Debra Daugomah
• Luvey Deatherage, PA-C
• Susan Dethman, CDR
• East Central Oklahoma Family Health Center, Inc.
• Andrea Denese Edwards
• Tracy Lynn Farrill, PHARMD
• Melissa D Findley, LPC
• Renee Foulks, BS, CMII
• Ronald Fried, D.O.
• Juanita Gates

• Skilled Nursing Facility in Wewoka, OK
• Providers in Wewoka, 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 Jan 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.