MEDICARE: OAKMONT EAST-GREENVILLE SC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	NCF-444	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316980170
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OAKMONT EAST-GREENVILLE SC LLC

Provider Business Mailing Address
First Line	:	333 N SUMMIT ST
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43604-2615
Country	:	US
Telephone Number	:	419-252-5500
Fax Number	:	877-385-9446

Provider Business Practice Location Address
First Line	:	601 SULPHUR SPRINGS RD
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29617-1621
Country	:	US
Telephone Number	:	864-246-2721
Fax Number	:	864-246-7563

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. MARTIN D ALLEN
Credential	:
Telephone Number	:	419-252-5734

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	01/24/2022

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