Olive Mountain Residential Care LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

033209 Issued in MO

Legal business name

OLIVE MOUNTAIN RESIDENTIAL CARE LLC

Practice address

25466 N Hwy 5
Lebanon, MO 65536-0969

Phone

(417) 532-3045

Fax

(417) 532-4104

NPI assigned

Jul 6, 2006

Organization subpart

No

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

Authorized official

Name

Miss Stephanie Nichole Upton

Title

Financial Manager

Phone

(417) 532-3045

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1811929623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 969",
            "city": "LEBANON",
            "state": "MO",
            "postal_code": "655360969",
            "telephone_number": "417-532-3045",
            "fax_number": "417-532-4104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25466 N HWY 5",
            "city": "LEBANON",
            "state": "MO",
            "postal_code": "655360969",
            "telephone_number": "417-532-3045",
            "fax_number": "417-532-4104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLIVE MOUNTAIN RESIDENTIAL CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "UPTON",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_middle_name": "NICHOLE",
        "authorized_official_title_or_position": "FINANCIAL MANAGER",
        "authorized_official_telephone_number": "417-532-3045",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MO",
            "license": "033209",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chukwudi Emmanuel Nwodo, M.D.
• O.C.C.S., Inc.
• Shane R Ogle, D.C.
• Tabitha Lynn Ogle, D.C
• Sharron Fiona Oleniacz, CRNA
• Barry E Olson, MD
• Lisa Osborn, CRNA
• Jose S Padilla Jr., MD
• Anthony Jacob Pappas, M.D.
• Cynthia Denise Parker, LPC

• Assisted Living Facility in Lebanon, MO
• Providers in Lebanon, MO by specialty
• Assisted Living Facility in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.