Provider Demographics
NPI:1669403036
Name:OAKS NURSING HOME INC
Entity type:Organization
Organization Name:OAKS NURSING HOME INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ OPERATOR - ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JULE
Authorized Official - Last Name:WINDHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-967-2223
Mailing Address - Street 1:777 NURSING HOME RD
Mailing Address - Street 2:
Mailing Address - City:MARSHALLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31057-3715
Mailing Address - Country:US
Mailing Address - Phone:478-967-2223
Mailing Address - Fax:478-967-2224
Practice Address - Street 1:777 NURSING HOME RD
Practice Address - Street 2:
Practice Address - City:MARSHALLVILLE
Practice Address - State:GA
Practice Address - Zip Code:31057-3715
Practice Address - Country:US
Practice Address - Phone:478-967-2223
Practice Address - Fax:478-967-2224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1094120314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00142271AMedicaid
GA115627Medicare ID - Type Unspecified