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General NPI Number Information
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NPI Number | 1134676885
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Entity Type | Organization
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Legal Business Name | OAK RIDGE DISTINCTIVE SENIOR LIVING AND REHAB, LLC
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Dates
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Enumeration Date | 09/09/2016
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Last Update Date | 09/09/2016
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Provider Practice Location Address
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Address Line | 501 HUDSON ST
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City | EL DORADO
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State | AR
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Zip | 71730-6573
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Country | US
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Telephone | 314-536-2776
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Fax |
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Provider Business Mailing Address
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Address Line | 14615 MANCHESTER RD
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City | MANCHESTER
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State | MO
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Zip | 63011-3790
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Country | US
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Telephone | 314-225-7788
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Fax |
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Authorized Official
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Title or Position | SENIOR MEMBER
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Name | MR. RODNEY FORTE
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Credential |
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Telephone | 618-889-3778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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