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General NPI Number Information
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NPI Number | 1174770093
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Entity Type | Organization
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Legal Business Name | SILVER OAK COUNTRY ESTATES
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Dates
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Enumeration Date | 08/21/2008
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Last Update Date | 08/21/2008
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Provider Practice Location Address
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Address Line | 138 SUN VILLA CT
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City | VISTA
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State | CA
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Zip | 92084-5851
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Country | US
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Telephone | 760-216-6183
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Fax | 760-758-8613
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Provider Business Mailing Address
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Address Line | 138 SUN VILLA CT
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City | VISTA
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State | CA
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Zip | 92084-5851
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Country | US
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Telephone | 760-216-6183
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Fax | 760-758-8613
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Authorized Official
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Title or Position | ADMINSTRATOR
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Name | MS. LORENA ECKERT
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Credential | RN
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Telephone | 760-216-6183
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 374602670
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License Number State | CA
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