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NPI Code Detail

MEDICARE: OAKLAND MANOR NURSING CENTER, LP

MEDICARE: OAKLAND MANOR NURSING CENTER, LP
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
1314000000XSkilled Nursing Facility108720TX

General Provider Information

NPI Number : 1679554018
Entity Type Code : Organization
Provider Name (Legal Business Name) : OAKLAND MANOR NURSING CENTER, LP
Provider Business Mailing Address
First Line : 1400 N MAIN ST
Second Line :
City : GIDDINGS
State : TX
Zip : 78942-1360
Country : US
Telephone Number : 979-542-1755
Fax Number : 979-542-7002
Provider Business Practice Location Address
First Line : 1400 N MAIN ST
Second Line :
City : GIDDINGS
State : TX
Zip : 78942-1360
Country : US
Telephone Number : 979-542-1755
Fax Number : 979-542-7002
Authorized Official
Title or Position : MDS / PPS NURSE
Name : MS. CARLY LYNN WALLACE
Credential : LVN
Telephone Number : 979-542-1755
Provider Enumeration Date : 11/11/2005
Last Update Date : 08/22/2020

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Directions to “OAKLAND MANOR NURSING CENTER, LP ” Practice Location

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