37D0720953 CLIA NUMBER - SHAWN MANOR NURSING HOME CONHOLD OF PONCA CITY, LLC

Laboratory Demographics

  • CLIA Code: 37D0720953
  • Facility Name: SHAWN MANOR NURSING HOME CONHOLD OF PONCA CITY, LLC
  • Facility Address: 2024 TURNER RD
    PONCA CITY, OK
    ZIP 74604
  • Facility Phone: 580 765-3364
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: JAMIE K. SULLIVAN
  • NPI Number: 1164461570
  • Taxonomy: 313M00000X - Nursing Facility/Intermediate Care Facility

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CLIA Record

Field Name Field Value
CLIA Number 37D0720953
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name SHAWN MANOR NURSING HOME CONHOLD OF PONCA CITY, LLC
Street 2024 TURNER RD
City PONCA CITY
State OK
ZIP 74604
Phone 580 765-3364
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director JAMIE K. SULLIVAN

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This page was last updated on: 9/29/2025