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General NPI Number Information
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NPI Number | 1477897254
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Entity Type | Organization
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Legal Business Name | OAKS PRIVATE HOME CARE
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Dates
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Enumeration Date | 11/19/2012
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Last Update Date | 11/19/2012
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Provider Practice Location Address
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Address Line | 1782 FORDHAM AVE
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-2033
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Country | US
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Telephone | 805-358-5985
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Fax |
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Provider Business Mailing Address
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Address Line | 1782 FORDHAM AV
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-2033
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Country | US
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Telephone | 805-358-5985
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. SEWASEW FANTAYE
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Credential | RN
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Telephone | 805-358-5985
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 525671
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License Number State | CA
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