Provider Demographics
NPI:1508973280
Name:OAK GROVE NURSING HOME INC
Entity Type:Organization
Organization Name:OAK GROVE NURSING HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:FELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-963-1266
Mailing Address - Street 1:6230 WARREN ST
Mailing Address - Street 2:
Mailing Address - City:GROVES
Mailing Address - State:TX
Mailing Address - Zip Code:77619-4214
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6230 WARREN ST
Practice Address - Street 2:
Practice Address - City:GROVES
Practice Address - State:TX
Practice Address - Zip Code:77619-4214
Practice Address - Country:US
Practice Address - Phone:409-963-1266
Practice Address - Fax:409-962-9622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5906313M00000X
TX509601314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000509601Medicaid
TX676122Medicare Oscar/Certification