HEAVENER MANOR, LLC
NPI 1174941496
Skilled Nursing Facility in Heavener, OK

Active since April 03, 2014CLIA 37D0670462 · Waiver
204 W 1ST ST, HEAVENER, OK 74937(918) 653-2034(918) 653-4518 Get Directions Write a Review

NPPES record last updated: June 7, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Heavener Manor, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

HEAVENER MANOR, LLC (NPI 1174941496) is a healthcare organization registered as a skilled nursing facility in Heavener, Oklahoma and active in the NPI registry since April 2014. The organization holds a CLIA Waiver certificate valid through August 31, 2026 and lists Bradford Montgomery, Member, as its authorized official.

NPPES Registry Identity

NPI1174941496
Entity TypeOrganization
Primary Taxonomy314000000X
Legal Business NameHEAVENER MANOR, LLC
Location Address204 W 1ST STHeavener, OK 74937-2062
Mailing Address9 Professional DrBella Vista, AR 72715-8462 · (479) 259-5558
Fax(918) 653-4518
Organization SubpartNo
Authorized OfficialBradford MontgomeryMember · (479) 250-5558
Enumeration DateApril 3, 2014
Last NPPES UpdateJune 7, 2024
NPPES CertifiedJune 7, 2024
NPI 1174941496 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtySkilled Nursing FacilityNursing & Custodial Care Facilities
Taxonomy Code314000000X
License Licensed in OK · NH4001-4001
Definition
(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.
204 W 1ST ST, Heavener, OK 74937

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 37D0670462

Heavener Manor · Heavener, OK
Active · expires Aug 31, 2026
CLIA Number37D0670462
Laboratory TypeSkilled Nursing Facility/Nursing Facility
Certificate Effective DateSeptember 1, 2024
Certificate Expiration DateAugust 31, 2026
Laboratory DirectorAnnette Ramsey
Laboratory Phone(918) 653-2464
Laboratory LocationHeavener Manor114 West 2nd Street, Heavener, OK 74937
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Skilled Nursing Facility
204 W 1ST ST
HEAVENER, OK 74937

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Heavener Manor, LLC's NPI number?

The NPI number for Heavener Manor, LLC is 1174941496. It was assigned to this organization in the NPPES registry on April 3, 2014.

Where is Heavener Manor, LLC located?

Heavener Manor, LLC is located at 204 W 1st St, Heavener, OK 74937. The listed phone number is (918) 653-2034.

What is Heavener Manor, LLC's specialty?

The primary specialty registered for this NPI is Skilled Nursing Facility with taxonomy code 314000000X.

Does Heavener Manor, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 37D0670462) is associated with this NPI, valid through August 31, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Heavener Manor, LLC was last updated on June 7, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.