Healthcare Provider Details

I. General information

NPI: 1346056181
Provider Name (Legal Business Name): OAK TREE HOMES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2024
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27370 HAMMETT CT
MORENO VALLEY CA
92555-4998
US

IV. Provider business mailing address

27370 HAMMETT CT
MORENO VALLEY CA
92555-4998
US

V. Phone/Fax

Practice location:
  • Phone: 213-645-9866
  • Fax:
Mailing address:
  • Phone: 213-645-9866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: ENOH STEPHEN UDOFFIA
Title or Position: CEO
Credential:
Phone: 213-645-9866