Provider Demographics
NPI:1639296676
Name:SILVER OAK SENRIOR LIVING MANAGEMENT, LC
Entity Type:Organization
Organization Name:SILVER OAK SENRIOR LIVING MANAGEMENT, LC
Other - Org Name:SILVER OAK SENIOR LIVING AT LAMAR
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:417-682-6184
Mailing Address - Street 1:3 SW 1ST LN
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:MO
Mailing Address - Zip Code:64759-1772
Mailing Address - Country:US
Mailing Address - Phone:417-682-6184
Mailing Address - Fax:417-682-9185
Practice Address - Street 1:3 SW 1ST LN
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:MO
Practice Address - Zip Code:64759-1772
Practice Address - Country:US
Practice Address - Phone:417-682-6184
Practice Address - Fax:417-682-9185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO031519310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility