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General NPI Number Information
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NPI Number | 1629348297
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Entity Type | Organization
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Legal Business Name | OAK FENCE SENIOR LIVING
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Dates
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Enumeration Date | 01/12/2012
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Last Update Date | 01/12/2012
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Provider Practice Location Address
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Address Line | 6036 OAK FENCE LN
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City | LANCASTER
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State | CA
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Zip | 93536-1794
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Country | US
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Telephone | 909-967-1872
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Fax | 667-718-8648
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Provider Business Mailing Address
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Address Line | 6036 WEST OAK FENCE LANE
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City | LANCASTER
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State | CA
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Zip | 93536
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Country | US
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Telephone | 909-967-1872
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Fax | 667-718-8648
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Authorized Official
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Title or Position | OWNER
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Name | MS. THAN T AYE
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Credential |
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Telephone | 909-967-1872
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number | 197607406
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License Number State | CA
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