Basic Information
| Provider Information | |||||||||
| NPI: | 1225474851 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LAMAR SENIOR LIVING, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MAPLE SENIOR LIVING OF LAMAR | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 S 4TH ST STE 1900 | ||||||||
| Address2: | ATTN: LEGAL DEPT. | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402024436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5027794700 | ||||||||
| FaxNumber: | 5027794749 | ||||||||
| Practice Location | |||||||||
| Address1: | 3 SW 1ST LN | ||||||||
| Address2: | |||||||||
| City: | LAMAR | ||||||||
| State: | MO | ||||||||
| PostalCode: | 647591772 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4176826184 | ||||||||
| FaxNumber: | 4176826185 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2013 | ||||||||
| LastUpdateDate: | 05/22/2013 | ||||||||
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| AuthorizedOfficialLastName: | HUDSON | ||||||||
| AuthorizedOfficialFirstName: | W. | ||||||||
| AuthorizedOfficialMiddleName: | BRYAN | ||||||||
| AuthorizedOfficialTitleorPosition: | EVP, GENERAL COUNSEL AND SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 5027794700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | 041096 | MO | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.