Healthcare Provider Details

I. General information

NPI: 1679023253
Provider Name (Legal Business Name): WHITE OAK HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2016
Last Update Date: 12/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1926 RIDGE AVE SE
WARREN OH
44484-2821
US

IV. Provider business mailing address

544 ENTERPRISE DR
LEWIS CENTER OH
43035-9704
US

V. Phone/Fax

Practice location:
  • Phone: 937-825-6622
  • Fax:
Mailing address:
  • Phone: 937-825-6622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateOH

VIII. Authorized Official

Name: PAUL BERGSTEN
Title or Position: CEO
Credential:
Phone: 937-825-6622