MEDICARE: OAK CREST NURSING CENTER

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	112017	TX

General Provider Information

NPI Number	:	1538147467
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OAK CREST NURSING CENTER

Provider Business Mailing Address
First Line	:	1902 FM 3036
Second Line	:
City	:	ROCKPORT
State	:	TX
Zip	:	78382-9691
Country	:	US
Telephone Number	:	361-729-9971
Fax Number	:	361-729-1499

Provider Business Practice Location Address
First Line	:	1902 FM 3036
Second Line	:
City	:	ROCKPORT
State	:	TX
Zip	:	78382-9691
Country	:	US
Telephone Number	:	361-729-9971
Fax Number	:	361-729-1499

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. JERRY ANTHONY TREVINO
Credential	:	LNFA
Telephone Number	:	361-729-9971

Provider Enumeration Date	:	12/30/2005
Last Update Date	:	08/22/2020

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Directions to “OAK CREST NURSING CENTER ” Practice Location

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