Healthcare Provider Details

I. General information

NPI: 1497472260
Provider Name (Legal Business Name): OAK HOLLOW OF GEORGETOWN REHABILITATION CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 10/24/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2715 S ISLAND RD
GEORGETOWN SC
29440-4415
US

IV. Provider business mailing address

416 NUWAY CIR TRLR 25
LENOIR NC
28645-9004
US

V. Phone/Fax

Practice location:
  • Phone: 919-710-4521
  • Fax:
Mailing address:
  • Phone: 919-710-4521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JAMES ALLEN CUNNINGHAM
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 919-710-4521