=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104826486
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ODD FELLOWS HOME OF CALIFORNIA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2005
-----------------------------------------------------
Last Update Date | 12/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1800 ATRIUM PKWY
-----------------------------------------------------
City | NAPA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94559-4837
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-257-7885
-----------------------------------------------------
Fax | 707-257-6915
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1800 ATRIUM PKWY
-----------------------------------------------------
City | NAPA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94559-4837
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-257-7885
-----------------------------------------------------
Fax | 707-257-6915
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MRS. KRISTI N MORROW
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 707-256-9297
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 110000292
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------