Provider Demographics
NPI:1093930448
Name:ROYAL OAKS RETIREMENT CENTER
Entity Type:Organization
Organization Name:ROYAL OAKS RETIREMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:OVERSTREET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-237-3321
Mailing Address - Street 1:PO BOX 459
Mailing Address - Street 2:211 COLLEGE STREET
Mailing Address - City:ADRIAN
Mailing Address - State:GA
Mailing Address - Zip Code:31002-0459
Mailing Address - Country:US
Mailing Address - Phone:478-237-3321
Mailing Address - Fax:
Practice Address - Street 1:211 COLLEGE ST.
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:GA
Practice Address - Zip Code:31002-0459
Practice Address - Country:US
Practice Address - Phone:478-237-3321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053-02-005-9310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000933589AMedicaid