Organization
OAK GROVE RETIREMENT HOME, INC.
Active
Other names
Oak Grove Retirement Home
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES E SMITH I LNHA (ADMENISTRATOR)
(662) 395-2577
Entity
Organization
Contact information
Practice address
200 OAK CIRCLE, N/A, DUNCAN, MS 38740
(662) 395-2577
(662) 395-2568
Mailing address
201 OAK CIRCLE, N/A, DUNCAN, MS 38740
(662) 395-2577
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
00023100
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00023110
—
MS
Enumeration date
08/28/2006
Last updated
10/07/2008
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