Provider Demographics
NPI:1518604206
Name:ASPIRE SENIOR LIVING OAK GROVE, LLC
Entity Type:Organization
Organization Name:ASPIRE SENIOR LIVING OAK GROVE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-968-9629
Mailing Address - Street 1:1115 W FULTON MARKET FL 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-1213
Mailing Address - Country:US
Mailing Address - Phone:704-968-9692
Mailing Address - Fax:
Practice Address - Street 1:2108 SW MITCHELL ST
Practice Address - Street 2:
Practice Address - City:OAK GROVE
Practice Address - State:MO
Practice Address - Zip Code:64075-9472
Practice Address - Country:US
Practice Address - Phone:816-690-4118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility