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General NPI Number Information
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NPI Number | 1295171445
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Entity Type | Organization
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Legal Business Name | LIVE OAK MANOR ASSISTED LIVING FACILITY
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Dates
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Enumeration Date | 05/15/2013
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Last Update Date | 05/15/2013
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Provider Practice Location Address
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Address Line | 5660 MAUNA LOA BLVD
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City | SARASOTA
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State | FL
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Zip | 34240-8930
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Country | US
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Telephone | 941-377-2868
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Fax | 941-377-8824
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Provider Business Mailing Address
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Address Line | 5660 MAUNA LOA BLVD
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City | SARASOTA
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State | FL
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Zip | 34240-8930
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Country | US
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Telephone | 941-377-2868
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Fax | 941-377-8824
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Authorized Official
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Title or Position | OWNER-ADMINISTRATOR
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Name | KIMBERLY LENNON-JOTHAM
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Credential |
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Telephone | 941-377-2868
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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 | AL6039
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License Number State | FL
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