Provider Demographics
NPI:1417944752
Name:FIVE OAKS MANOR LLC
Entity Type:Organization
Organization Name:FIVE OAKS MANOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSING HOME ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:KNEELAND
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:704-788-2131
Mailing Address - Street 1:413 WINECOFF SCHOOL ROAD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-4175
Mailing Address - Country:US
Mailing Address - Phone:704-788-2131
Mailing Address - Fax:704-786-1557
Practice Address - Street 1:413 WINECOFF SCHOOL ROAD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-4175
Practice Address - Country:US
Practice Address - Phone:704-788-2131
Practice Address - Fax:704-786-1557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0027310400000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3415186Medicaid
NC3416170Medicaid
NC3416170Medicaid
NC4739870001Medicare NSC