Healthcare Provider Details

I. General information

NPI: 1982984274
Provider Name (Legal Business Name): GREAT OAKS HEALTHCARE MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2011
Last Update Date: 08/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5303 VAUGHN RD
MONTGOMERY AL
36116-1120
US

IV. Provider business mailing address

5303 VAUGHN RD
MONTGOMERY AL
36116-1120
US

V. Phone/Fax

Practice location:
  • Phone: 334-386-0343
  • Fax: 334-386-0382
Mailing address:
  • Phone: 334-386-0343
  • Fax: 334-386-0382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: VICKI F LAWRENSON
Title or Position: OWNER
Credential:
Phone: 334-386-0343