Oak Grove Assisted Living Facility, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

OAK GROVE ASSISTED LIVING FACILITY, LLC

Practice address

5483 Neff Lake Rd
Brooksville, FL 34601-7842

Phone

(352) 796-3733

NPI assigned

Aug 25, 2021

Organization subpart

No

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

Authorized official

Name

Jason PetersenNPI 1669041356

Title

Owner

Phone

(720) 244-9712

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Oak Grove ALF Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jason Petersen

  • Assisted Living Facility
  • Brooksville, FL
  • NPI 1669041356
  NPD Authorized official

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

{
    "created_epoch": "1629849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629849600000",
    "number": "1982371233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21107 BIRCHOLM CT",
            "city": "LAND O LAKES",
            "state": "FL",
            "postal_code": "346377464",
            "telephone_number": "720-244-9712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5483 NEFF LAKE RD",
            "city": "BROOKSVILLE",
            "state": "FL",
            "postal_code": "346017842",
            "telephone_number": "352-796-3733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OAK GROVE ASSISTED LIVING FACILITY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-25",
        "last_updated": "2021-08-25",
        "certification_date": "2021-08-25",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "720-244-9712"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "111276900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Oak Grove ALF",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Brooksville, FL
• Providers in Brooksville, FL by specialty
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.