=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932181385
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OAKS NURSING HOME, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/18/2005
-----------------------------------------------------
Last Update Date | 12/10/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 507 W JACKSON ST
-----------------------------------------------------
City | BURNET
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78611-3012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-756-6044
-----------------------------------------------------
Fax | 512-756-2646
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 507 W JACKSON ST
-----------------------------------------------------
City | BURNET
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78611-3012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-756-6044
-----------------------------------------------------
Fax | 512-756-2646
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMIN. ASSIST.
-----------------------------------------------------
Name | MRS. ROBIN GUENTER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 512-756-6044
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 115359
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------