Provider Demographics
NPI:1760434724
Name:GREAT OAKS REHABILITATION AND HEALTHCARE CENTER, LLC
Entity Type:Organization
Organization Name:GREAT OAKS REHABILITATION AND HEALTHCARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT AND SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:MEER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:629-262-0000
Mailing Address - Street 1:111 CHASE ST
Mailing Address - Street 2:
Mailing Address - City:BYHALIA
Mailing Address - State:MS
Mailing Address - Zip Code:38611-7395
Mailing Address - Country:US
Mailing Address - Phone:662-838-3670
Mailing Address - Fax:662-838-3740
Practice Address - Street 1:111 CHASE ST
Practice Address - Street 2:
Practice Address - City:BYHALIA
Practice Address - State:MS
Practice Address - Zip Code:38611-7395
Practice Address - Country:US
Practice Address - Phone:662-838-3670
Practice Address - Fax:662-838-3740
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARK MISSISSIPPI HOLDING COMPANY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-17
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS984314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS79709Medicaid
MS79709Medicaid