Healthcare Provider Details

I. General information

NPI: 1255604559
Provider Name (Legal Business Name): GORDAN OAKS AT GREYSTOKE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2012
Last Update Date: 08/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3151A KNOLLWOOD DR
MOBILE AL
36693-2745
US

IV. Provider business mailing address

105 PATROL RD SUITE D
FORSYTH GA
31029-1800
US

V. Phone/Fax

Practice location:
  • Phone: 251-661-7608
  • Fax: 251-602-9146
Mailing address:
  • Phone: 478-994-3669
  • Fax: 478-994-3664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL E WINGET SR.
Title or Position: MANAGER
Credential:
Phone: 478-994-3669