Organization
EASTSIDE MANOR INC. DBA SOUTHERN OAKS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GAIL ROBERTA BOUDREAU (EXECUTIVE DIRECTOR)
(864) 288-3271
Entity
Organization
Contact information
Practice address
120 ROPER MOUNTAIN ROAD EXT, GREENVILLE, SC 29615-4823
(864) 288-3271
(864) 365-0697
Mailing address
120 ROPER MOUNTAIN ROAD EXT, GREENVILLE, SC 29615-4823
(864) 288-3271
(864) 365-0697
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
CRC0611
SC
Other
Enumeration date
06/10/2014
Last updated
06/10/2014
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