Provider Demographics
NPI:1871555490
Name:OAK CREST VILLAGE, INC
Entity type:Organization
Organization Name:OAK CREST VILLAGE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:K
Authorized Official - Last Name:WALTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-402-2315
Mailing Address - Street 1:8820 WALTHER BLVD
Mailing Address - Street 2:ATTN: EXECUTIVE DIRECTOR
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-9025
Mailing Address - Country:US
Mailing Address - Phone:410-655-1000
Mailing Address - Fax:410-204-7237
Practice Address - Street 1:8832 WALTHER BLVD
Practice Address - Street 2:ATTN: EXTENDED CARE ADMINISTRATOR
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-9020
Practice Address - Country:US
Practice Address - Phone:410-655-1000
Practice Address - Fax:410-204-7237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03-071314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD215308Medicare Oscar/Certification