Provider Demographics
NPI:1396862348
Name:SILVER OAK SENIOR LIVING MANAGEMENT, LC
Entity Type:Organization
Organization Name:SILVER OAK SENIOR LIVING MANAGEMENT, LC
Other - Org Name:SILVER OAK SENIOR LIVING AT BUTLER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:CROSBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-679-0866
Mailing Address - Street 1:300 S DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:MO
Mailing Address - Zip Code:64730-2014
Mailing Address - Country:US
Mailing Address - Phone:660-679-0866
Mailing Address - Fax:660-679-0867
Practice Address - Street 1:300 S DELAWARE ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:MO
Practice Address - Zip Code:64730-2014
Practice Address - Country:US
Practice Address - Phone:660-679-0866
Practice Address - Fax:660-679-0867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO033792310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO268207602Medicaid