Healthcare Provider Details

I. General information

NPI: 1639009517
Provider Name (Legal Business Name): SONOMA OAK TREE HOME RCFE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 ARBOR AVE
SONOMA CA
95476-4501
US

IV. Provider business mailing address

425 ARBOR AVE
SONOMA CA
95476-4501
US

V. Phone/Fax

Practice location:
  • Phone: 707-996-4706
  • Fax:
Mailing address:
  • Phone: 707-996-4706
  • Fax:

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: DINA BURK
Title or Position: LICENSEE
Credential:
Phone: 925-360-1827