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General NPI Number Information
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NPI Number | 1164023693
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Entity Type | Organization
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Legal Business Name | OAK SENIOR CARE, LLC
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Dates
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Enumeration Date | 11/02/2020
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Last Update Date | 11/02/2020
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Provider Practice Location Address
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Address Line | 111 S WALNUT ST
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City | OAKLAND
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State | IL
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Zip | 61943-7232
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Country | US
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Telephone | 217-346-2042
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Fax | 217-346-2046
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Provider Business Mailing Address
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Address Line | PO BOX 974
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City | OAKLAND
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State | IL
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Zip | 61943-0974
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Country | US
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Telephone | 217-346-2042
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Fax | 217-346-2046
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. MARIJO EISBRENNER
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Credential | PHD, CNA
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Telephone | 941-799-1552
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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 |
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License Number State |
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