Healthcare Provider Details

I. General information

NPI: 1225474851
Provider Name (Legal Business Name): LAMAR SENIOR LIVING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2013
Last Update Date: 05/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 SW 1ST LN
LAMAR MO
64759-1772
US

IV. Provider business mailing address

401 S 4TH ST STE 1900 ATTN: LEGAL DEPT.
LOUISVILLE KY
40202-4436
US

V. Phone/Fax

Practice location:
  • Phone: 417-682-6184
  • Fax: 417-682-6185
Mailing address:
  • Phone: 502-779-4700
  • Fax: 502-779-4749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number041096
License Number StateMO

VIII. Authorized Official

Name: W. BRYAN HUDSON
Title or Position: EVP, GENERAL COUNSEL AND SECRETARY
Credential:
Phone: 502-779-4700