Basic Information
| Provider Information | |||||||||
| NPI: | 1669839452 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHG OPERATOR 031 LLC | ||||||||
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| OtherOrganizationName: | OAK HILL HEALTHCARE RESIDENCE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 CLIFTON AVE | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087013342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143963462 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1100 GEORGIA ST | ||||||||
| Address2: | |||||||||
| City: | JONES | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730497556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053992294 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2016 | ||||||||
| LastUpdateDate: | 02/03/2016 | ||||||||
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| AuthorizedOfficialLastName: | NEUMAN | ||||||||
| AuthorizedOfficialFirstName: | JOSEF | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2143963462 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | OK | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.