Ok4 Broadway Opco LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

OK4 BROADWAY OPCO LLC

Doing business as

Broadway Manor Nursing Home

Practice address

1622 E Broadway St
Muskogee, OK 74403-4601

Phone

(918) 683-2851

NPI assigned

May 17, 2016

Last updated

Oct 29, 2024By 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

Isaac Dole

Title

Manager/Principal

Phone

(773) 645-9246

Specialties & licenses 1

Addresses

Other names 1

• Broadway Manor Nursing Home Doing business as

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

{
    "created_epoch": "1463443200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730160000000",
    "number": "1952758294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1622 E BROADWAY ST",
            "city": "MUSKOGEE",
            "state": "OK",
            "postal_code": "744034601",
            "telephone_number": "918-683-2851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1622 E BROADWAY ST",
            "city": "MUSKOGEE",
            "state": "OK",
            "postal_code": "744034601",
            "telephone_number": "918-683-2851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OK4 BROADWAY OPCO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-17",
        "last_updated": "2024-10-29",
        "certification_date": "2024-10-29",
        "status": "A",
        "authorized_official_last_name": "DOLE",
        "authorized_official_first_name": "ISAAC",
        "authorized_official_title_or_position": "MANAGER/PRINCIPAL",
        "authorized_official_telephone_number": "773-645-9246"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OK",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Broadway Manor Nursing Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ray V Odom Jr., OD
• Elizabeth Oferczak, RD/LD
• Dare M Oganla
• Jimmy Keith Ogden, APRN, DC
• Dena Marie Ohl, PTA
• Ok4 Eastgate Opco LLC (Eastgate Village Retirement Center)
• Ok4 Home Health Agency LLC (Outreach Home Health)
• Ok4 Hospice LLC (Hometown Hospice)
• Okc Dental Health Associates, P.C. (MyDentist-Muskogee)
• Okie Pain Clinic Inc

• Skilled Nursing Facility in Muskogee, OK
• Providers in Muskogee, 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 Oct 29, 2024; 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.