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General NPI Number Information
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NPI Number | 1326143587
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Entity Type | Organization
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Legal Business Name | LIVE OAK INN, INC
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 619 W LIVE OAK ST
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City | FREDERICKSBURG
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State | TX
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Zip | 78624-4415
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Country | US
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Telephone | 830-997-4391
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Fax | 830-990-9711
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Provider Business Mailing Address
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Address Line | 619 W LIVE OAK ST
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City | FREDERICKSBURG
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State | TX
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Zip | 78624-4415
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Country | US
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Telephone | 830-997-4391
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Fax | 830-990-9711
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. KATY C MILBERT
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Credential |
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Telephone | 830-990-4391
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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 | 4204
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License Number State | TX
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