Healthcare Provider Details

I. General information

NPI: 1336470111
Provider Name (Legal Business Name): OAK PARK HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2010
Last Update Date: 09/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 OAK PARK BLVD
PLEASANT HILL CA
94523-4487
US

IV. Provider business mailing address

801 BROAD ST SUITE 300
CHATTANOOGA TN
37402-2671
US

V. Phone/Fax

Practice location:
  • Phone: 925-935-5222
  • Fax: 925-935-5211
Mailing address:
  • Phone: 423-308-1845
  • Fax: 423-398-1844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. PERRY BYRON DEFOOR
Title or Position: OWNER
Credential:
Phone: 423-308-1845