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General NPI Number Information
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NPI Number | 1851588727
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Entity Type | Organization
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Legal Business Name | FAIR OAKS ESTATES
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Dates
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Enumeration Date | 09/25/2007
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Last Update Date | 05/09/2024
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Provider Practice Location Address
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Address Line | 8845 FAIR OAKS BLVD
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City | CARMICHAEL
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State | CA
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Zip | 95608-2652
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Country | US
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Telephone | 916-944-2077
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Fax | 916-944-3167
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Provider Business Mailing Address
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Address Line | 8845 FAIR OAKS BLVD
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City | CARMICHAEL
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State | CA
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Zip | 95608-2652
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Country | US
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Telephone | 916-944-2077
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Fax | 916-944-3167
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Authorized Official
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Title or Position | LICENSEE/CEO
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Name | MR. KIRT HAMBURG
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Credential |
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Telephone | 916-944-2077
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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 | 347001356
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License Number State | CA
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