Provider Demographics
NPI:1053347674
Name:OAKVIEW NURSING & REHABILITATION CENTER LLC
Entity type:Organization
Organization Name:OAKVIEW NURSING & REHABILITATION CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:CAVIN
Authorized Official - Last Name:BULLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-857-4761
Mailing Address - Street 1:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30747-0449
Mailing Address - Country:US
Mailing Address - Phone:706-857-4761
Mailing Address - Fax:706-857-4230
Practice Address - Street 1:960 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:GA
Practice Address - Zip Code:30747-1930
Practice Address - Country:US
Practice Address - Phone:706-857-4761
Practice Address - Fax:706-857-4230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-027-1732314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
51043194 001OtherBCBS
GA000142238AMedicaid
115428Medicare Oscar/Certification