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General NPI Number Information
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NPI Number | 1124272349
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Entity Type | Organization
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Legal Business Name | SILVER OAK SENIOR LIVING MANAGEMENT, LC
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Dates
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Enumeration Date | 11/14/2008
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Last Update Date | 11/14/2008
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Provider Practice Location Address
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Address Line | 1501 E ASHLAND ST
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City | NEVADA
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State | MO
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Zip | 64772-4025
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Country | US
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Telephone | 417-667-5953
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Fax |
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Provider Business Mailing Address
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Address Line | 3720 E 2ND ST
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City | EDMOND
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State | OK
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Zip | 73034-7303
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. SAM CROSBY
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Credential |
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Telephone | 405-705-2420
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 035556
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License Number State | MO
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