LIVE OAK HOLDINGS LLC NPI 1972961415

NPI Information

  • NPI: 1972961415
  • Provider Name: LIVE OAK HOLDINGS, LLC
  • Classification: Assisted Living Facility - 310400000X
  • Entity Type: Organization
  • Doing Business As: GOVERNOR'S RIDGE RETIREMENT
  • CLIA Number: 45D2203476
  • Address: 300 E DEVEREAUX ST
    DECATUR, TX
    ZIP 76234
  • Phone: (940) 627-1104

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NPI Details

LIVE OAK HOLDINGS, LLC is an assisted living facility in Decatur, TX. The provider is a facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. LIVE OAK HOLDINGS, LLC NPI is 1972961415. The provider is registered as an organization entity type.
The provider Is Doing Business As Governor's Ridge Retirement.

The provider's business location address is:

300 E DEVEREAUX ST
DECATUR, TX
ZIP 76234-033
Phone: (940) 627-1104
Fax: (940) 627-1159

The provider's authorized official is Allan Erselius .
The authorized official title is Chief Operating Officer and has the following contact phone number (562) 301-9819.

The CLIA number assigned to this NPI record is 45D2203476 - assisted living facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/28/2016 and was last updated on 1/28/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1310400000XAssisted Living Facility141222TEXASYes

What is NPI?

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This page was last updated on: 11/21/2025

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