MEDICARE: LIVE OAK MANOR, 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
1	314000000X	Skilled Nursing Facility	230000199	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700885019
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVE OAK MANOR, INC.

Provider Business Mailing Address
First Line	:	4020 SIERRA COLLEGE BLVD
Second Line	:	SUITE 190
City	:	ROCKLIN
State	:	CA
Zip	:	95677-3906
Country	:	US
Telephone Number	:	916-624-6230
Fax Number	:	916-624-6249

Provider Business Practice Location Address
First Line	:	9000 LARKIN RD
Second Line	:
City	:	LIVE OAK
State	:	CA
Zip	:	95953-9599
Country	:	US
Telephone Number	:	530-695-8020
Fax Number	:	530-695-1843

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	LARRY E BEAR
Credential	:
Telephone Number	:	916-624-6230

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	06/10/2008

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Directions to “LIVE OAK MANOR, INC. ” Practice Location

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