Provider Demographics
NPI:1457688962
Name:OAK GROVE CENTER
Entity Type:Organization
Organization Name:OAK GROVE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:PAULES
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:207-873-0721
Mailing Address - Street 1:27 COOL ST
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-5221
Mailing Address - Country:US
Mailing Address - Phone:207-873-0721
Mailing Address - Fax:207-877-2287
Practice Address - Street 1:27 COOL ST
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-5221
Practice Address - Country:US
Practice Address - Phone:207-873-0721
Practice Address - Fax:207-877-2287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA3557314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility