Provider Demographics
NPI:1700832870
Name:OAK KNOLL HEALTH AND REHABILITATION, LLC
Entity Type:Organization
Organization Name:OAK KNOLL HEALTH AND REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:CODY
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-391-3600
Mailing Address - Street 1:824 6TH AVE W
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35204-3402
Mailing Address - Country:US
Mailing Address - Phone:205-787-2619
Mailing Address - Fax:
Practice Address - Street 1:824 6TH AVE W
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35204-3402
Practice Address - Country:US
Practice Address - Phone:205-787-2619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL014225OtherBCBS ID
AL4757570SMedicaid
AL4757570SMedicaid