EASTSIDE MANOR INC. DBA SOUTHERN OAKS (NPI# 1205249927) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205249927 |
| Entity Type | Organization |
| Organization Name | EASTSIDE MANOR INC. DBA SOUTHERN OAKS |
| Practice Address |
120 Roper Mountain Road Ext Greenville SC 29615-4823 |
| Practice Telephone | 8642883271 |
| Practice Fax Number | 8643650697 |
| Mailing Telephone | 8642883271 |
| Mailing Fax Number | 8643650697 |
| Enumeration Date | 2014-06-10 |
| Last Update Date | 2014-06-10 |
| Authorized Official Name | MRS. GAIL ROBERTA BOUDREAU (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 8642883271 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | CRC0611 | SC | Nursing & Custodial Care Facilities |
| Street Address |
120 ROPER MOUNTAIN ROAD EXT |
| City | GREENVILLE |
| State | SC |
| Zip Code | 29615-4823 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194358051 | Adenike Orogade | Behavior Technician | 17 Caldedon Ct, Suite B, Greenville, SC 29615 | 2020-02-19 |
| 1629608369 | Jennifer Jacobsen | Behavior Technician | 17 Caldedon Court, Suite B, Greenville, SC 29615 | 2020-01-22 |
| 1932668217 | Carolina Orthopaedic and Neurosurgical Associates | Orthopaedic Surgery | Carolina Orthopaedic and Neurosurgical Associates, 220 Roper Mountain Road Extension, Greenville, SC 29615 | 2019-03-18 |
| 1255816070 | Trevis L Cureton | Pharmacist | 2401 East North St, Greenville, SC 29615 | 2018-09-27 |
| 1497232565 | Jacob J Fountain | Nurse Practitioner | 225 Enterprise Blvd, Suite 101, Greenville, SC 29615 | 2018-07-23 |
| 1346726924 | St. Francis Physician Services, Inc | Internal Medicine | 5 Hoke Smith Blvd, Greenville, SC 29615 | 2018-07-17 |
| 1558853101 | Alexandra Michelle Taylor | Audiologist | 200 Patewood Dr Ste 400, Greenville, SC 29615 | 2018-05-30 |
| 1316466543 | Mariah Hope Mosher | Behavioral Analyst | 7 Mckenna Commons Court, Greenvilee, SC 29615 | 2017-09-19 |
| 1326400896 | Karen L Heaps | Counselor | 3150 S. Hwy 14, The Pelham Center, Greenville, SC 29615 | 2016-03-24 |
| 1134589013 | Sharon Erk | Technician, Other | 2950 E.norths St, Greenville, OH 29615 | 2016-03-04 |
| Find all providers in zip 29615 | ||||
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144680786 | Art Enterprise of Pitt Co. | Assisted Living Facility | 110 Pearl Dr, Greenville, NC 27834-8517 | 2016-02-24 |
| 1740668755 | Broadway Manor Limited Liability | Assisted Living Facility | 446 N Broadway Street, Greenville, MS 38701-2552 | 2015-05-11 |
| 1710390810 | Gahcr II Greenville Alf Trs Sub, LLC | Assisted Living Facility | 605 S Dewey St, Greenville, IL 62246-2296 | 2014-06-05 |
| 1366764227 | Brookdale Senior Living Communities Inc | Assisted Living Facility | 1401 N Broadway St, Greenville, OH 45331-4300 | 2010-02-19 |
| 1184860918 | Brookdale Senior Living Communities, Inc. | Assisted Living Facility | 2105 W Arlington Blvd, Greenville, NC 27834-5744 | 2008-12-29 |
| 1093967218 | Cascades Nursing, LLC | Assisted Living Facility | 10 Fountainview Terrace, Greenville, SC 29607-4033 | 2008-10-21 |
| 1285821595 | Assisted Living Concepts Inc | Assisted Living Facility | 1275 Northview Drive, Greenville, OH 45331 | 2007-10-01 |
| 1093900425 | Emerald Glen Managment | Assisted Living Facility | 605 Dewey St, Greenville, IL 62246-2296 | 2007-09-10 |
| 1104946433 | Rosa Bradley Home for Adults | Assisted Living Facility | 2215 North Memorial Drive, Greenville, NC 27835 | 2007-03-30 |
| 1043337330 | Cortland Place Health Center, Inc | Assisted Living Facility | 20 Austin Avenue, Greenville, RI 02828 | 2007-03-23 |
| Find all providers in GREENVILLE | ||||
| City | GREENVILLE |
| Zip Code | 29615 |
Please comment or provide details below to improve the information on EASTSIDE MANOR INC. DBA SOUTHERN OAKS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.