Healthcare Provider Details

I. General information

NPI: 1700126893
Provider Name (Legal Business Name): GRAND OAKS OF OKEECHOBEE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2013
Last Update Date: 11/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 SE 2ND ST
OKEECHOBEE FL
34974-4401
US

IV. Provider business mailing address

2400 SE MONTEREY RD SUITE 300
STUART FL
34996-3351
US

V. Phone/Fax

Practice location:
  • Phone: 863-824-6770
  • Fax:
Mailing address:
  • Phone: 772-286-1844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL11944
License Number StateFL

VIII. Authorized Official

Name: MR. DONALD R CROW
Title or Position: CEO
Credential:
Phone: 772-286-1844