Basic Information
| Provider Information | |||||||||
| NPI: | 1578039467 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LAVERNA SENIOR LIVING LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3225 EMERALD LN STE B | ||||||||
| Address2: | |||||||||
| City: | JEFFERSON CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 651096869 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5735566240 | ||||||||
| FaxNumber: | 5735566241 | ||||||||
| Practice Location | |||||||||
| Address1: | 904 S HALL AVE | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | MO | ||||||||
| PostalCode: | 644851952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8163243185 | ||||||||
| FaxNumber: | 8163244097 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2018 | ||||||||
| LastUpdateDate: | 10/17/2018 | ||||||||
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| AuthorizedOfficialLastName: | SCHEULEN | ||||||||
| AuthorizedOfficialFirstName: | BENJAMIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF OPERATING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 5735566240 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.