EASTWOOD MANOR, LLC — NPI 1417058470 (Licensed & Credentialed Nursing and Custodial Care Facilities

CMS-1500 Box 24J / 33a • NPI

1417058470

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

313M00000X (CMS A3[10])

Licensed & Credentialed Nursing and Custodial Care Facilities — Nursing Facility

Box 32 Service Location & ZIP+4

519 N MICKEY MANTLE BLVD, COMMERCE, OK, 74339-1127

✓ 9-Digit EDI 837 ZIP+4 (74339-1127)

Practice Phone & Referral Fax

(918) 675-4455

Fax: (918) 675-5472

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1417058470 (EASTWOOD MANOR, LLC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1417058470` (NPI-2 Organization / Facility)
Provider / Legal Name	EASTWOOD MANOR, LLC
Plain-English Specialty	Licensed & Credentialed Nursing and Custodial Care Facilities — Nursing Facility NUCC Code: `313M00000X` (Nursing Facility/Intermediate Care Facility)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	519 N MICKEY MANTLE BLVD, COMMERCE, OK, 74339-1127
Practice Telephone / Fax	Tel: (918) 675-4455 \| Fax: (918) 675-5472
Administrative Mailing Address	PO BOX 429, SALLISAW, OK, 74955-0429
Enumeration & Last Sync	Enumerated: 2006-09-25 \| CMS Record Updated: 2008-07-16
Authorized Official	KEVIN MORAN (Business Management)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

519 N MICKEY MANTLE BLVD, COMMERCE, OK, 74339-1127

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Plain-English Taxonomy & CMS Crosswalk (313M00000X)

What Does Taxonomy Code 313M00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 313M00000X translates to:
"Licensed & Credentialed Nursing and Custodial Care Facilities — Nursing Facility"

CMS-1500 Medicare Specialty Crosswalk: CMS Code A3[10] (Other Nursing Facility)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Nursing Facility/Intermediate Care Facility for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (EASTWOOD MANOR, LLC)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`313M00000X` — Nursing Facility/Intermediate Care Facility Plain English: Licensed & Credentialed Nursing and Custodial Care Facilities — Nursing Facility	State: OK \| License: `NH5802-5802` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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EASTWOOD MANOR, LLC (NPI #1417058470)