Provider Demographics
NPI:1922493592
Name:OAKTREE HEALTH AND REHABILITATION CENTER, LLC
Entity Type:Organization
Organization Name:OAKTREE HEALTH AND REHABILITATION CENTER, LLC
Other - Org Name:CHRISTIAN CARE CENTER OF MEMPHIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:R
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-975-5455
Mailing Address - Street 1:2020 NORTHPARK DR
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-3100
Mailing Address - Country:US
Mailing Address - Phone:423-975-5455
Mailing Address - Fax:423-975-5405
Practice Address - Street 1:6500 KIRBY GATE CV
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-8203
Practice Address - Country:US
Practice Address - Phone:901-752-0772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-01
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ021687Medicaid
TNQ021686Medicaid
445522Medicare Oscar/Certification