Healthcare Provider Details

I. General information

NPI: 1053347674
Provider Name (Legal Business Name): OAKVIEW NURSING & REHABILITATION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 HIGHLAND AVE
SUMMERVILLE GA
30747-1930
US

IV. Provider business mailing address

PO BOX 449
SUMMERVILLE GA
30747-0449
US

V. Phone/Fax

Practice location:
  • Phone: 706-857-4761
  • Fax: 706-857-4230
Mailing address:
  • Phone: 706-857-4761
  • Fax: 706-857-4230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1-027-1732
License Number StateGA

VIII. Authorized Official

Name: KIMBERLY CAVIN BULLARD
Title or Position: ADMINISTRATOR
Credential:
Phone: 706-857-4761