Provider Demographics
NPI:1538147467
Name:OAK CREST NURSING CENTER
Entity type:Organization
Organization Name:OAK CREST NURSING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:TREVINO
Authorized Official - Suffix:
Authorized Official - Credentials:LNFA
Authorized Official - Phone:361-729-9971
Mailing Address - Street 1:1902 FM 3036
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:TX
Mailing Address - Zip Code:78382-9691
Mailing Address - Country:US
Mailing Address - Phone:361-729-9971
Mailing Address - Fax:361-729-1499
Practice Address - Street 1:1902 FM 3036
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:TX
Practice Address - Zip Code:78382-9691
Practice Address - Country:US
Practice Address - Phone:361-729-9971
Practice Address - Fax:361-729-1499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112017314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility