Provider Demographics
NPI:1700126893
Name:GRAND OAKS OF OKEECHOBEE, INC.
Entity Type:Organization
Organization Name:GRAND OAKS OF OKEECHOBEE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:CROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-286-1844
Mailing Address - Street 1:2400 SE MONTEREY RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34996-3351
Mailing Address - Country:US
Mailing Address - Phone:772-286-1844
Mailing Address - Fax:
Practice Address - Street 1:203 SE 2ND ST
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34974-4401
Practice Address - Country:US
Practice Address - Phone:863-824-6770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-26
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11944310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility