Healthcare Provider Details

I. General information

NPI: 1174157721
Provider Name (Legal Business Name): OAKVIEW-ELDORADO OAKS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2020
Last Update Date: 02/22/2020
Certification Date: 02/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1762 DALE RD
GLENDORA CA
91740-5431
US

IV. Provider business mailing address

PO BOX 217
GLENDORA CA
91740-0217
US

V. Phone/Fax

Practice location:
  • Phone: 626-221-3061
  • Fax:
Mailing address:
  • Phone: 626-221-3061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State

VIII. Authorized Official

Name: ISABELLE M YOUNGMAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 626-221-3061