Oak Grove Retirement Opco LLC

Primary specialty

Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X

Legal business name

OAK GROVE RETIREMENT OPCO LLC

Doing business as

Oak Grove Retirement Home

Practice address

209 Oak Cir
Duncan, MS 38740-5520

Phone

(662) 395-2577

Fax

(662) 395-2576

NPI assigned

May 18, 2022

Last updated

Aug 9, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ethan Dreifus

Title

Authorized Signatory

Phone

(501) 961-8100

Specialties & licenses 1

Addresses

Other names 1

• Oak Grove Retirement Home Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1652832000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691539200000",
    "number": "1811634157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8250",
            "city": "SEARCY",
            "state": "AR",
            "postal_code": "721458250",
            "telephone_number": "501-254-0007",
            "fax_number": "888-866-9887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 OAK CIR",
            "city": "DUNCAN",
            "state": "MS",
            "postal_code": "387405520",
            "telephone_number": "662-395-2577",
            "fax_number": "662-395-2576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OAK GROVE RETIREMENT OPCO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-18",
        "last_updated": "2023-08-09",
        "certification_date": "2023-08-09",
        "status": "A",
        "authorized_official_last_name": "DREIFUS",
        "authorized_official_first_name": "ETHAN",
        "authorized_official_title_or_position": "AUTHORIZED SIGNATORY",
        "authorized_official_telephone_number": "501-961-8100"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Oak Grove Retirement Home",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Oak Grove Retirement Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Duncan Nursing and Rehabilitation
• Making Moves in the Community, Incorporated
• North Bolivar School District (Epsdt Screening)
• Oak Circle Operating LLC
• Oak Grove Retirement Home, Inc.

• Nursing Facility/Intermediate Care Facility in Duncan, MS
• Providers in Duncan, MS by specialty
• Nursing Facility/Intermediate Care Facility in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.