Provider Demographics
NPI:1033294764
Name:OAK HEALTH CARE INVESTORS OF MT. VERNON, INC.
Entity Type:Organization
Organization Name:OAK HEALTH CARE INVESTORS OF MT. VERNON, INC.
Other - Org Name:THE LAURELS OF MT. VERNON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-794-8800
Mailing Address - Street 1:13 AVALON RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-1403
Mailing Address - Country:US
Mailing Address - Phone:740-397-3200
Mailing Address - Fax:740-397-4326
Practice Address - Street 1:13 AVALON RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-1403
Practice Address - Country:US
Practice Address - Phone:740-397-3200
Practice Address - Fax:740-397-4326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5240332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000157631OtherBC/BS #
OH5240OtherNH LICENSE #
OH994090Medicaid
OH7105592OtherUNITED HEALTH CARE ID #
OH994090Medicaid