NPIMap

Organization Active NPI

Palladian Senior Care of Poplar Bluff LLC.

Doing business as Oakdale Care Center

  • Skilled Nursing Facility
  • Poplar Bluff, MO
National Provider Identifier
1558359760
Registry record updated Mar 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
031709 Issued in MO
Legal business name
PALLADIAN SENIOR CARE OF POPLAR BLUFF LLC.
Doing business as
Oakdale Care Center
Practice address
2702 Debbie LN
Poplar Bluff, MO 63901-2650
Phone
(573) 686-5242
Fax
(573) 686-3637
NPI assigned
Oct 11, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2024

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

Authorized official

Name
Mr. Michael Jason Mills
Title
Cfo
Phone
(314) 317-2003

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 031709 MO Primary

Addresses

Primary practice location

2702 Debbie LN
Poplar Bluff, MO 63901-2650

Mailing address

500 NW Plaza Dr Ste 712
Saint Ann, MO 63074-2222
Phone (314) 566-0459

Other identifiers 1

IdentifierTypeStateIssuer
106774102MedicaidMO

Other names 1

  • Oakdale Care Center Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Ability Network

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170518000678 MO Part A Provider - Skilled Nursing Facility 1254608458 Practice locations: Poplar Bluff, MO

Skilled nursing facility certification: CCN 265556

Legal name
PALLADIAN SENIOR CARE OF POPLAR BLUFF LLC
Doing business as
OAKDALE CARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Dec 1, 1993
Last certification
Oct 24, 2024
Beds
70
Ownership / control type
Corporation
Multi-facility organization
Palladian Senior Care of PB, LLC
Organization structure
LLCProprietary
Incorporated
Oct 21, 2016 in IL
Enrollment address
2702 Debbie Lane
Poplar Bluff, MO 63901-2650
Nursing home name
OAKDALE CARE CENTER
Affiliated entity
PALLADIAN HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Oakdale Care CenterCCN 265556 · All quality measures
Overall star rating
3 of 5
Health inspections
4 of 5
Staffing
1 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Dec 1, 1993
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
7064.9 residents per day on average
Chain
Palladian Healthcare6 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
26D0889526Oakdale Care Center2702 Debbie Lane, Poplar Bluff, MO 63901Certificate of waiverJul 31, 2026

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.

Locations

2702 Debbie Ln
#340
Poplar Bluff, MO 63901
Phone (573) 686-5242

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Jeff Edward Newman Individual 5% Or Greater Direct Ownership Interest Oct 21, 2016 20%
Stephen P Miller Individual Contracted Managing EmployeePresident Apr 28, 2017 80%
5% Or Greater Direct Ownership Interest Apr 28, 2017 80%
Corporate OfficerPresident Apr 28, 2017 100%

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 4

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1128988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710720000000",
    "number": "1558359760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 NW PLAZA DR STE 712",
            "city": "SAINT ANN",
            "state": "MO",
            "postal_code": "630742222",
            "telephone_number": "314-566-0459",
            "fax_number": "573-686-3637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2702 DEBBIE LN",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639012650",
            "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": "2005-10-11",
        "last_updated": "2024-03-18",
        "certification_date": "2024-03-18",
        "status": "A",
        "authorized_official_last_name": "MILLS",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "JASON",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "314-317-2003",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MO",
            "license": "031709",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "106774102",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "64 S Price Rd Ste B",
            "city": "Brownsville",
            "state": "TX",
            "country_code": "US",
            "postal_code": "785212459",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Oakdale Care Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Oakdale Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Poplar Bluff, MO

Sources for this page

Verify at the official NPI Registry.