Organization
LAKE OZARK RETIREMENT CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TOM OTKE (PRESIDENT/OWNER)
(573) 659-6607
Entity
Organization
Contact information
Practice address
872 COLLEGE BLVD, OSAGE BEACH, MO 65065-8688
(573) 302-0900
(573) 302-0146
Mailing address
872 COLLEGE BLVD, OSAGE BEACH, MO 65065
(573) 302-0900
(573) 302-0146
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
030631
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
108303207
—
MO
Enumeration date
11/17/2005
Last updated
10/09/2008
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