Palladian Senior Care of Poplar Bluff LLC.

Primary specialty

Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X

License

031624 Issued in MO

Legal business name

PALLADIAN SENIOR CARE OF POPLAR BLUFF LLC.

Doing business as

Oakdale Care Center RCF

Practice address

2704 Debbie LN
Poplar Bluff, MO 63901-2650

Phone

(573) 686-5242

NPI assigned

Nov 17, 2006

Organization subpart

No

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

Addresses

Other identifiers 1

Other names 1

• Oakdale Care Center RCF Doing business as

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.

• Palladian Senior Care of Poplar Bluff LLC.

  dba Oakdale Care Center ALF

  • Assisted Living Facility
  • Poplar Bluff, MO
  • NPI 1487728887
  NPD tax ID
• Palladian Senior Care of Poplar Bluff LLC.

  dba Oakdale Care Center

  • Skilled Nursing Facility
  • Poplar Bluff, MO
  • NPI 1558359760
  NPD tax ID

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

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622764800000",
    "number": "1932273331",
    "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": "314-317-2003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2704 DEBBIE LN",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639012650",
            "telephone_number": "573-686-5242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALLADIAN SENIOR CARE OF POPLAR BLUFF LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-17",
        "last_updated": "2021-06-04",
        "certification_date": "2021-06-04",
        "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": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": "MO",
            "license": "031624",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "266774124",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Oakdale Care Center RCF",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Silvia Pagoada Vallecillo, M.D.
• Christal Dawn Painter
• Natosha Renea Painter
• Palladian Senior Care of Poplar Bluff LLC. (Oakdale Care Center ALF)
• Palladian Senior Care of Poplar Bluff LLC. (Oakdale Care Center)
• Costas Achilles Papanicolaou
• Julia Papanicolaou, RDH
• Amanda Gail Parker, CRNA
• Chelsea Rae Parkin
• Donna Lynn Parkinson, PH.D.

• Assisted Living Facility (Mental Illness) in Poplar Bluff, MO
• Providers in Poplar Bluff, MO by specialty
• Assisted Living Facility (Mental Illness) in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2021; 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.