Healthcare Provider Details

I. General information

NPI: 1730124546
Provider Name (Legal Business Name): TWIN OAKS NURSING HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 11/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

857 CRAWFORD LN
MOBILE AL
36617-3877
US

IV. Provider business mailing address

1 SOUTHERN WAY
MOBILE AL
36619-1210
US

V. Phone/Fax

Practice location:
  • Phone: 251-476-3420
  • Fax: 251-476-0323
Mailing address:
  • Phone: 251-433-9801
  • Fax: 251-433-9807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number12640
License Number StateAL

VIII. Authorized Official

Name: MR. GEORGE MICHAEL MIXON
Title or Position: ADMINISTRATOR
Credential:
Phone: 251-476-3420