Provider Demographics
NPI:1710206966
Name:OSMAN LLC
Entity Type:Organization
Organization Name:OSMAN LLC
Other - Org Name:COUNTRYHAVEN 2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER LLC
Authorized Official - Prefix:MR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAUDHRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-630-2414
Mailing Address - Street 1:2322 MUELLER LN
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-1411
Mailing Address - Country:US
Mailing Address - Phone:314-630-2414
Mailing Address - Fax:314-383-3353
Practice Address - Street 1:19235 STATE ROUTE EE
Practice Address - Street 2:
Practice Address - City:STE GENEVIEVE
Practice Address - State:MO
Practice Address - Zip Code:63670-8213
Practice Address - Country:US
Practice Address - Phone:573-756-8141
Practice Address - Fax:573-756-9141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO037932310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility