Basic Information
| Provider Information | |||||||||
| NPI: | 1982984274 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GREAT OAKS HEALTHCARE MANAGEMENT, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5303 VAUGHN RD | ||||||||
| Address2: | |||||||||
| City: | MONTGOMERY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 361161120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3343860343 | ||||||||
| FaxNumber: | 3343860382 | ||||||||
| Practice Location | |||||||||
| Address1: | 5303 VAUGHN RD | ||||||||
| Address2: | |||||||||
| City: | MONTGOMERY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 361161120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3343860343 | ||||||||
| FaxNumber: | 3343860382 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2011 | ||||||||
| LastUpdateDate: | 08/18/2011 | ||||||||
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| AuthorizedOfficialLastName: | LAWRENSON | ||||||||
| AuthorizedOfficialFirstName: | VICKI | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3343860343 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.