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General NPI Number Information
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NPI Number | 1255604559
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Entity Type | Organization
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Legal Business Name | GORDAN OAKS AT GREYSTOKE LLC
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Dates
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Enumeration Date | 02/16/2012
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Last Update Date | 08/11/2014
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Provider Practice Location Address
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Address Line | 3151A KNOLLWOOD DR
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City | MOBILE
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State | AL
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Zip | 36693-2745
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Country | US
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Telephone | 251-661-7608
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Fax | 251-602-9146
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Provider Business Mailing Address
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Address Line | 105 PATROL RD SUITE D
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City | FORSYTH
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State | GA
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Zip | 31029-1800
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Country | US
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Telephone | 478-994-3669
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Fax | 478-994-3664
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Authorized Official
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Title or Position | MANAGER
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Name | MICHAEL E WINGET SR.
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Credential |
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Telephone | 478-994-3669
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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