OrganizationOk4 Broadway Opco Llc(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 Ok4 Broadway Opco Llc 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 3 days ago.Profile DetailsProvider ID1952758294Provider TypeOrganizationFull NameOk4 Broadway Opco LlcOther NameBroadway Manor Nursing HomeSubpartNoEnumeration Date5/17/2016Last Updated5/27/2016Contact InformationPractice LocationPractice Address1622 E Broadway St, Muskogee, OK 74403-4601Phone(918) 683-2851FaxUnlisted FaxMailing LocationMailing Address1622 E Broadway St, Muskogee, OK 74403-4601Phone(918) 683-2851FaxUnlisted FaxAuthorized OfficialNameDole, Isaac (Manager/Principal)Phone(312) 724-8950Provider TaxonomiesCodeDescriptionLicenseCode314000000XPrimaryDescriptionSkilled Nursing FacilityNursing & Custodial Care FacilitiesLicenseUnlisted IssuerOklahoma