NPIMap

Organization Active NPI

Oak Grove Manor, Inc

  • Skilled Nursing Facility
  • Idabel, OK
National Provider Identifier
1891784070
Registry record updated Feb 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
NH4505-4505 Issued in OK
Legal business name
OAK GROVE MANOR, INC
Practice address
Highway 259 South
Idabel, OK 74745
Phone
(580) 286-2537
NPI assigned
Oct 19, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2008

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

Authorized official

Name
Mr. Dewey Dewayne Pebworth
Title
Administrator
Phone
(580) 286-2537

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X NH4505-4505 OK
Skilled Nursing Facility 314000000X NH4505-4505 OK Primary

Addresses

Primary practice location

Highway 259 South
Idabel, OK 74745

Mailing address

PO Box 299
Idabel, OK 74745-0299
Phone (580) 286-2537

National Provider Directory

National Provider Directory
Tax ID family
Oak View Health Services6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1129680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203897600000",
    "number": "1891784070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 299",
            "city": "IDABEL",
            "state": "OK",
            "postal_code": "747450299",
            "telephone_number": "580-286-2537",
            "fax_number": "580-286-5480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "HIGHWAY 259 SOUTH",
            "city": "IDABEL",
            "state": "OK",
            "postal_code": "74745",
            "telephone_number": "580-286-2537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OAK GROVE MANOR, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-19",
        "last_updated": "2008-02-25",
        "status": "A",
        "authorized_official_last_name": "PEBWORTH",
        "authorized_official_first_name": "DEWEY",
        "authorized_official_middle_name": "DEWAYNE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "580-286-2537",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "OK",
            "license": "NH4505-4505",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OK",
            "license": "NH4505-4505",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Idabel, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2008; 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.