Provider Demographics
NPI:1952494668
Name:OAK RIDGE MANOR, INC.
Entity Type:Organization
Organization Name:OAK RIDGE MANOR, INC.
Other - Org Name:OAK RIDGE MANOR, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MONTE
Authorized Official - Middle Name:H
Authorized Official - Last Name:READ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-773-9533
Mailing Address - Street 1:2501 MORRIS SHEPPARD DR
Mailing Address - Street 2:
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76801-5919
Mailing Address - Country:US
Mailing Address - Phone:325-643-2746
Mailing Address - Fax:325-643-3702
Practice Address - Street 1:2501 MORRIS SHEPPARD DR.
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801
Practice Address - Country:US
Practice Address - Phone:325-643-2746
Practice Address - Fax:325-643-3702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110470314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164433801Medicaid
TX000524801Medicaid
TX000524801Medicaid