Healthcare Provider Details

I. General information

NPI: 1639289861
Provider Name (Legal Business Name): OAKHURST MANOR PERSONAL CARE HOME INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 LEXINGTON RD
ELGIN TX
78621-1204
US

IV. Provider business mailing address

826 LEXINGTON RD
ELGIN TX
78621-1204
US

V. Phone/Fax

Practice location:
  • Phone: 512-285-3673
  • Fax: 512-281-0217
Mailing address:
  • Phone: 512-285-3673
  • Fax: 512-281-0217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number117671
License Number StateTX

VIII. Authorized Official

Name: MRS. MADELYN LORRAINE ASHBY
Title or Position: CEO/OWNER
Credential: M OTR
Phone: 512-285-3673