Healthcare Provider Details

I. General information

NPI: 1861338972
Provider Name (Legal Business Name): GLEN CREEK VILLA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8510 ELM AVE
ORANGEVALE CA
95662-2612
US

IV. Provider business mailing address

8510 ELM AVENUE
ORANGEVALE CA
95662
US

V. Phone/Fax

Practice location:
  • Phone: 916-988-8285
  • Fax: 916-988-8285
Mailing address:
  • Phone: 916-988-8285
  • Fax: 916-988-8285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM GEORGE OSANU
Title or Position: LICENSEE
Credential:
Phone: 916-298-4402