Provider Demographics
NPI:1164023693
Name:OAK SENIOR CARE, LLC
Entity Type:Organization
Organization Name:OAK SENIOR CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIJO
Authorized Official - Middle Name:
Authorized Official - Last Name:EISBRENNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, CNA
Authorized Official - Phone:941-799-1552
Mailing Address - Street 1:PO BOX 974
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61943-0974
Mailing Address - Country:US
Mailing Address - Phone:217-346-2042
Mailing Address - Fax:217-346-2046
Practice Address - Street 1:111 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:IL
Practice Address - Zip Code:61943-7232
Practice Address - Country:US
Practice Address - Phone:217-346-2042
Practice Address - Fax:217-346-2046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5201964OtherIDPH STATE ASSISTED LIVING LICENSE