Provider Demographics
NPI:1841246329
Name:OAKBRIDGE HEALTH CARE ASSOCIATES LLC
Entity Type:Organization
Organization Name:OAKBRIDGE HEALTH CARE ASSOCIATES LLC
Other - Org Name:OAKBRIDGE HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:S
Authorized Official - Last Name:KMET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-648-4800
Mailing Address - Street 1:3110 OAKBRIDGE BLVD E
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-5987
Mailing Address - Country:US
Mailing Address - Phone:863-648-4800
Mailing Address - Fax:863-646-9224
Practice Address - Street 1:3110 OAKBRIDGE BLVD E
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-5987
Practice Address - Country:US
Practice Address - Phone:863-648-4800
Practice Address - Fax:863-646-9224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF13770961314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL025992600Medicaid
105739Medicare Oscar/Certification