NPIMap

Organization Active NPI

Palladian Senior Care of Poplar Bluff LLC.

Doing business as Oakdale Care Center ALF

  • Assisted Living Facility
  • Poplar Bluff, MO
National Provider Identifier
1487728887
Registry record updated Apr 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
032301 Issued in MO
Legal business name
PALLADIAN SENIOR CARE OF POPLAR BLUFF LLC.
Doing business as
Oakdale Care Center ALF
Practice address
2711 Debbie LN
Poplar Bluff, MO 63901-2651
Phone
(573) 686-5242
Fax
(573) 686-3637
NPI assigned
Nov 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Jeff Edward Newman
Title
Administrator
Phone
(573) 686-5242

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 032301 MO Primary

Addresses

Primary practice location

2711 Debbie LN
Poplar Bluff, MO 63901-2651

Mailing address

PO Box 340
2711 Debbie Lane
Poplar Bluff, MO 63902-0340
Phone (573) 686-5242

Other identifiers 1

IdentifierTypeStateIssuer
266734904MedicaidMO

Other names 1

  • Oakdale Care Center ALF Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Ability Network3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524009600000",
    "number": "1487728887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 340",
            "address_2": "2711 DEBBIE LANE",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639020340",
            "telephone_number": "573-686-5242",
            "fax_number": "573-686-3637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2711 DEBBIE LN",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639012651",
            "telephone_number": "573-686-5242",
            "fax_number": "573-686-3637"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALLADIAN SENIOR CARE OF POPLAR BLUFF LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-17",
        "last_updated": "2018-04-18",
        "status": "A",
        "authorized_official_last_name": "NEWMAN",
        "authorized_official_first_name": "JEFF",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "573-686-5242",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MO",
            "license": "032301",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "266734904",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Oakdale Care Center ALF",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Poplar Bluff, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.