Basic Information
| Provider Information | |||||||||
| NPI: | 1396862348 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SILVER OAK SENIOR LIVING MANAGEMENT, LC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SILVER OAK SENIOR LIVING AT BUTLER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 S DELAWARE ST | ||||||||
| Address2: | |||||||||
| City: | BUTLER | ||||||||
| State: | MO | ||||||||
| PostalCode: | 647302014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6606790866 | ||||||||
| FaxNumber: | 6606790867 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 S DELAWARE ST | ||||||||
| Address2: | |||||||||
| City: | BUTLER | ||||||||
| State: | MO | ||||||||
| PostalCode: | 647302014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6606790866 | ||||||||
| FaxNumber: | 6606790867 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2007 | ||||||||
| LastUpdateDate: | 07/31/2008 | ||||||||
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| AuthorizedOfficialLastName: | CROSBY | ||||||||
| AuthorizedOfficialFirstName: | SAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6606790866 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | 033792 | MO | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
ID Information
| ID | Type | State | Issuer | Description | 268207602 | 05 | MO | MEDICAID |