Healthcare Provider Details

I. General information

NPI: 1598578270
Provider Name (Legal Business Name): SHADY OAKS RETIREMENT HOME CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2025
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 UNIVERSITY AVE
VALLEJO CA
94591-4862
US

IV. Provider business mailing address

118 UNIVERSITY AVE
VALLEJO CA
94591-4862
US

V. Phone/Fax

Practice location:
  • Phone: 888-668-4084
  • Fax:
Mailing address:
  • Phone: 888-668-4084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: KRISTINE HAEL
Title or Position: DIRECTOR
Credential:
Phone: 760-296-7562