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General NPI Number Information
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NPI Number | 1912886342
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Entity Type | Organization
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Legal Business Name | OAK TREE RANCH SENIOR ASSISTED LIVING
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Dates
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Enumeration Date | 08/29/2025
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Last Update Date | 08/29/2025
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Provider Practice Location Address
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Address Line | 1482 OLIVET RD
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City | SANTA ROSA
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State | CA
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Zip | 95401-3811
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Country | US
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Telephone | 707-571-1122
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Fax |
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Provider Business Mailing Address
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Address Line | 1482 OLIVET RD
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City | SANTA ROSA
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State | CA
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Zip | 95401-3811
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Country | US
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Telephone | 707-571-1122
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Fax |
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | PAMELA JOHNSON
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Credential |
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Telephone | 707-291-5756
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number |
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License Number State |
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