Oak Grove Retirement Opco LLC
NPI #1811634157 in Duncan, Mississippi
Provider Information
- NPI Number
- 1811634157
- Entity Type
- Organization
- Organization Name
- Oak Grove Retirement Opco LLC
- Primary Specialty
- Nursing Facility/Intermediate Care Facility
- Enumeration Date
- May 18, 2022
- Last Updated
- Aug 9, 2023
Practice Location
- Address
- 209 OAK CIR
- City
- Duncan
- State
- Mississippi
- ZIP Code
- 38740-5520
- Phone
- (662) 395-2577
Authorized Official
- Name
- ETHAN DREIFUS
- Title
- AUTHORIZED SIGNATORY
- Phone
- (501) 961-8100
Specialties & Taxonomy Codes
| Specialty |
|---|
| Nursing Facility/Intermediate Care Facility |
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