Provider Demographics
NPI:1578039467
Name:LAVERNA SENIOR LIVING LLC
Entity Type:Organization
Organization Name:LAVERNA SENIOR LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHEULEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-556-6240
Mailing Address - Street 1:3225 EMERALD LN STE B
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-6869
Mailing Address - Country:US
Mailing Address - Phone:573-556-6240
Mailing Address - Fax:573-556-6241
Practice Address - Street 1:904 S HALL AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:MO
Practice Address - Zip Code:64485-1952
Practice Address - Country:US
Practice Address - Phone:816-324-3185
Practice Address - Fax:816-324-4097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility