=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750037222
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OAK CREST HEALTH & WELLNESS OPCO, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2022
-----------------------------------------------------
Last Update Date | 04/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 325 SELMA RD
-----------------------------------------------------
City | BESSEMER
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35020-2417
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-428-9383
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 325 SELMA RD
-----------------------------------------------------
City | BESSEMER
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35020-2417
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-883-7920
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | CHAIM N HERTZEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 901-930-6124
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------