Healthcare Provider Details

I. General information

NPI: 1093754459
Provider Name (Legal Business Name): OAK GROVE HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 OLD US 221 HWY
RUTHERFORDTON NC
28139-8670
US

IV. Provider business mailing address

518 OLD US 221 HWY
RUTHERFORDTON NC
28139-8670
US

V. Phone/Fax

Practice location:
  • Phone: 828-287-7655
  • Fax: 828-287-4459
Mailing address:
  • Phone: 828-287-7655
  • Fax: 828-287-4459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH0566
License Number StateNC

VIII. Authorized Official

Name: TIM LEHNER
Title or Position: MANAGER
Credential:
Phone: 770-698-9040