Lake Ozark Retirement Center, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

030631 Issued in MO

Legal business name

LAKE OZARK RETIREMENT CENTER, INC.

Practice address

872 College Blvd
Osage Beach, MO 65065-8688

Phone

(573) 302-0900

Fax

(573) 302-0146

NPI assigned

Nov 17, 2005

Last updated

Oct 9, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Tom Otke

Title

President/Owner

Phone

(573) 659-6607

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1132185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223510400000",
    "number": "1710969571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "872 COLLEGE BLVD",
            "city": "OSAGE BEACH",
            "state": "MO",
            "postal_code": "65065",
            "telephone_number": "573-302-0900",
            "fax_number": "573-302-0146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "872 COLLEGE BLVD",
            "city": "OSAGE BEACH",
            "state": "MO",
            "postal_code": "650658688",
            "telephone_number": "573-302-0900",
            "fax_number": "573-302-0146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE OZARK RETIREMENT CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-17",
        "last_updated": "2008-10-09",
        "status": "A",
        "authorized_official_last_name": "OTKE",
        "authorized_official_first_name": "TOM",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "573-659-6607",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MO",
            "license": "030631",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "108303207",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Skilled Nursing Facility in Osage Beach, MO
• Providers in Osage Beach, MO by specialty
• Skilled Nursing Facility in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2008; 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.