Provider Demographics
NPI:1891735387
Name:OAK MANOR LLC
Entity Type:Organization
Organization Name:OAK MANOR LLC
Other - Org Name:OAK MANOR INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHAIRMAN AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:L
Authorized Official - Last Name:PRUITT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:770-279-6200
Mailing Address - Street 1:409 E DOYLE ST
Mailing Address - Street 2:
Mailing Address - City:TOCCOA
Mailing Address - State:GA
Mailing Address - Zip Code:30577-2107
Mailing Address - Country:US
Mailing Address - Phone:706-886-8493
Mailing Address - Fax:706-827-2048
Practice Address - Street 1:205 PEACH ORCHARD RD
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:GA
Practice Address - Zip Code:30511-1803
Practice Address - Country:US
Practice Address - Phone:706-778-6746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home