MEDICARE: THE OAKS OF BLYTHEWOOD, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	NCF0959	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013231794
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE OAKS OF BLYTHEWOOD, INC.

Provider Business Mailing Address
First Line	:	1626 JEURGENS CT
Second Line	:
City	:	NORCROSS
State	:	GA
Zip	:	30093-2219
Country	:	US
Telephone Number	:	770-279-6200
Fax Number	:	770-931-5278

Provider Business Practice Location Address
First Line	:	1075 HEATHER GREEN DRIVE
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29229-0000
Country	:	US
Telephone Number	:	803-382-2300
Fax Number	:	803-382-2301

Authorized Official
Title or Position	:	CHAIRMAN AND CEO
Name	:	MR. NEIL L. PRUITT JR.
Credential	:
Telephone Number	:	770-279-6200

Provider Enumeration Date	:	03/24/2010
Last Update Date	:	01/25/2017

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