Basic Information
| Provider Information | |||||||||
| NPI: | 1285886226 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OAK FOREST HEALTH AND REHABILITATION COMPANY | ||||||||
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| OtherOrganizationName: | OAK FOREST HEALTH AND REHABILITATION | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 229 AIRPORT RD | ||||||||
| Address2: | SUITE 7-104 | ||||||||
| City: | ARDEN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287046402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196089123 | ||||||||
| FaxNumber: | 9198829771 | ||||||||
| Practice Location | |||||||||
| Address1: | 5680 WINDY HILL DR | ||||||||
| Address2: | |||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271051425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367765000 | ||||||||
| FaxNumber: | 9198829771 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2008 | ||||||||
| LastUpdateDate: | 10/09/2018 | ||||||||
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| AuthorizedOfficialLastName: | SPRENGER | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
| AuthorizedOfficialMiddleName: | JOHN | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9196089123 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | NH0548 | NC | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 3415443 | 05 | NC | MEDICAID | 3475443 | 05 | NC | MEDICAID |