Provider Demographics
NPI:1558635334
Name:LIVE OAK ASSISTED LIVING
Entity Type:Organization
Organization Name:LIVE OAK ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:FREDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-354-3680
Mailing Address - Street 1:PO BOX 13664
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31416-0664
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:340 EISENHOWER DR
Practice Address - Street 2:SUITE 1311
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-1600
Practice Address - Country:US
Practice Address - Phone:912-354-6011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-27
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000888709AMedicaid