Organization
OLIVE MOUNTAIN RESIDENTIAL CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS STEPHANIE NICHOLE UPTON (FINANCIAL MANAGER)
(417) 532-3045
Entity
Organization
Contact information
Practice address
25466 N HWY 5, LEBANON, MO 65536-0969
(417) 532-3045
(417) 532-4104
Mailing address
PO BOX 969, LEBANON, MO 65536-0969
(417) 532-3045
(417) 532-4104
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
033209
MO
Other
Enumeration date
07/06/2006
Last updated
08/22/2020
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