Healthcare Provider Details

I. General information

NPI: 1619050432
Provider Name (Legal Business Name): ADK OCEANSIDE OPERATOR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 06/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 ROSEWOOD AVE
TYBEE ISLAND GA
31328-9435
US

IV. Provider business mailing address

7 ROSEWOOD AVE
TYBEE ISLAND GA
31328-9435
US

V. Phone/Fax

Practice location:
  • Phone: 912-786-4511
  • Fax: 912-786-7414
Mailing address:
  • Phone: 912-786-4511
  • Fax: 912-786-7414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1-0251696
License Number StateGA

VIII. Authorized Official

Name: CAROL GROEBER
Title or Position: VICE PRESIDENT/MIS
Credential:
Phone: 937-964-8974