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General NPI Number Information
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NPI Number | 1508441460
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Entity Type | Organization
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Legal Business Name | OAK GROVE STREET OPERATING LLC
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Dates
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Enumeration Date | 03/12/2021
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Last Update Date | 12/17/2021
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Provider Practice Location Address
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Address Line | 706 OAK GROVE ST
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City | MOUNTAIN VIEW
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State | AR
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Zip | 72560-8601
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Country | US
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Telephone | 870-269-5845
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Fax |
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Provider Business Mailing Address
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Address Line | 317 MONMOUTH AVE STE 201
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City | LAKEWOOD
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State | NJ
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Zip | 08701-3209
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Country | US
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Telephone | 848-210-2175
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | YISROEL GANZ
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Credential |
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Telephone | 848-210-2175
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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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