MEDICARE: OAK FENCE SENIOR LIVING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	550002982	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	550002982	OTHER	CA	DEPARTMENT OF PUBLIC HEALTH

General Provider Information

NPI Number	:	1497140222
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OAK FENCE SENIOR LIVING, LLC

Provider Business Mailing Address
First Line	:	6067 WEST OAK FENCE LANE
Second Line	:
City	:	LANCASTER
State	:	CA
Zip	:	93536
Country	:	US
Telephone Number	:	661-270-2140
Fax Number	:

Provider Business Practice Location Address
First Line	:	6067 WEST OAK FENCE LANE
Second Line	:
City	:	LANCASTER
State	:	CA
Zip	:	93536
Country	:	US
Telephone Number	:	661-270-2140
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	THAN THAN AYE
Credential	:
Telephone Number	:	909-967-1872

Provider Enumeration Date	:	03/30/2015
Last Update Date	:	05/19/2020

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