Organization
OAK GROVE ASSISTED LIVING FACILITY, LLC
Active
Other names
Oak Grove ALF
Organization subpart
No
Provider details
NPI number
Authorized official
JASON PETERSEN (OWNER)
(720) 244-9712
Entity
Organization
Contact information
Practice address
5483 NEFF LAKE RD, BROOKSVILLE, FL 34601-7842
(352) 796-3733
Mailing address
21107 BIRCHOLM CT, LAND O LAKES, FL 34637-7464
(720) 244-9712
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111276900
—
FL
Enumeration date
08/25/2021
Last updated
08/25/2021
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