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NPI Code Detail

MEDICARE: SHADY LAWN LIVING CENTER, INC

MEDICARE: SHADY LAWN LIVING CENTER, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility040355MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2040355OTHERMOSKILLED NURSING HOME LICENSE NUMBER

General Provider Information

NPI Number : 1295081222
Entity Type Code : Organization
Provider Name (Legal Business Name) : SHADY LAWN LIVING CENTER, INC
Provider Business Mailing Address
First Line : P.O. BOX 277
Second Line :
City : SAVANNAH
State : MO
Zip : 64485-9431
Country : US
Telephone Number : 816-324-5991
Fax Number : 816-324-3556
Provider Business Practice Location Address
First Line : 13277 STATE ROUTE D
Second Line :
City : SAVANNAH
State : MO
Zip : 64485-9431
Country : US
Telephone Number : 816-324-5991
Fax Number : 816-324-3556
Authorized Official
Title or Position : VICE PRESIDENT
Name : MS. CHARLENE OSBY
Credential :
Telephone Number : 641-472-7482
Provider Enumeration Date : 07/27/2012
Last Update Date : 10/05/2015

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Directions to “SHADY LAWN LIVING CENTER, INC ” Practice Location

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