EASTSIDE MANOR INC. DBA SOUTHERN OAKS
NPI 1205249927
Assisted Living Facility in Greenville, SC

Q: What is Eastside Manor Inc. Dba Southern Oaks's specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

Active since June 10, 2014

120 ROPER MOUNTAIN ROAD EXT, GREENVILLE, SC 29615(864) 288-3271(864) 365-0697 Get Directions Write a Review

NPPES record last updated: June 10, 2014. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Eastside Manor Inc. Dba Southern Oaks NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EASTSIDE MANOR INC. DBA SOUTHERN OAKS (NPI 1205249927) is a healthcare organization registered as an assisted living facility in Greenville, South Carolina and active in the NPI registry since June 2014. The organization lists Gail Roberta Boudreau, Executive Director, as its authorized official.

NPPES Registry Identity

NPI1205249927

Entity TypeOrganization

Primary Taxonomy310400000X

Legal Business NameEASTSIDE MANOR INC. DBA SOUTHERN OAKS

Location Address120 ROPER MOUNTAIN ROAD EXTGreenville, SC 29615-4823

Mailing Address120 Roper Mountain Road ExtGreenville, SC 29615-4823 · (864) 288-3271 · Fax (864) 365-0697

Phone(864) 288-3271

Fax(864) 365-0697

Organization SubpartNo

Authorized OfficialGail Roberta BoudreauExecutive Director · (864) 288-3271

Enumeration DateJune 10, 2014

✔ NPI 1205249927 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities

Taxonomy Code310400000X

License✔ Licensed in SC · CRC0611

Definition

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.

120 ROPER MOUNTAIN ROAD EXT, Greenville, SC 29615

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Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LANDMARK RECOVERY OF COLUMBIA LLC

Substance Abuse Rehabilitation Facility

120 ROPER MOUNTAIN ROAD EXT
GREENVILLE, SC 29615

Greenville County (855) 950-5035

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Eastside Manor Inc. Dba Southern Oaks's NPI number?

The NPI number for Eastside Manor Inc. Dba Southern Oaks is 1205249927. It was assigned to this organization in the NPPES registry on June 10, 2014.

Where is Eastside Manor Inc. Dba Southern Oaks located?

Eastside Manor Inc. Dba Southern Oaks is located at 120 Roper Mountain Road Ext, Greenville, SC 29615. The listed phone number is (864) 288-3271.

What is Eastside Manor Inc. Dba Southern Oaks's specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

When was this NPI record last updated?

The NPPES record for Eastside Manor Inc. Dba Southern Oaks was last updated on June 10, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.