Provider Demographics
NPI:1144947912
Name:OAK HOLLOW OF SUMTER REHABILITATION CENTER LLC
Entity type:Organization
Organization Name:OAK HOLLOW OF SUMTER REHABILITATION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-710-4521
Mailing Address - Street 1:416 NUWAY CIR TRLR 25
Mailing Address - Street 2:
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-9004
Mailing Address - Country:US
Mailing Address - Phone:919-710-4521
Mailing Address - Fax:
Practice Address - Street 1:1761 PINEWOOD RD
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29154-9056
Practice Address - Country:US
Practice Address - Phone:803-481-8591
Practice Address - Fax:806-481-8601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility