OrganizationBroadway Manor Management L.L.C(Broadway Manor Nursing Home)Skilled Nursing FacilityNursing & Custodial Care FacilitiesPractice Address1622 E Broadway St, Muskogee, OK 74403-4601(918) 683-2851PECOS EnrollmentBased on the most recent information from CMS, provider Broadway Manor Management L.L.C does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1700885787Provider TypeOrganizationFull NameBroadway Manor Management L.L.COther NameBroadway Manor Nursing HomeSubpartNoEnumeration Date7/20/2005Last Updated8/22/2020Contact InformationPractice LocationPractice Address1622 E Broadway St, Muskogee, OK 74403-4601Phone(918) 683-2851Fax(918) 683-2992Mailing LocationMailing Address1622 E Broadway St, Muskogee, OK 74403-4601Phone(918) 683-2851Fax(918) 683-2992Authorized OfficialNameScott, Michael Thornton (Managing Member)Phone(918) 683-2851Provider TaxonomiesCodeDescriptionLicenseCode314000000XPrimaryDescriptionSkilled Nursing FacilityNursing & Custodial Care FacilitiesLicenseUnlisted IssuerOklahomaProvider IdentifiersIDDescriptionIssuerID000375146001DescriptionOtherIssuerBLUE CROSS BLUE SHIELDOklahoma