MEDICARE: SILVER OAK COUNTRY ESTATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	374602670	CA

General Provider Information

NPI Number	:	1174770093
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SILVER OAK COUNTRY ESTATES

Provider Business Mailing Address
First Line	:	138 SUN VILLA CT
Second Line	:
City	:	VISTA
State	:	CA
Zip	:	92084-5851
Country	:	US
Telephone Number	:	760-216-6183
Fax Number	:	760-758-8613

Provider Business Practice Location Address
First Line	:	138 SUN VILLA CT
Second Line	:
City	:	VISTA
State	:	CA
Zip	:	92084-5851
Country	:	US
Telephone Number	:	760-216-6183
Fax Number	:	760-758-8613

Authorized Official
Title or Position	:	ADMINSTRATOR
Name	:	MS. LORENA ECKERT
Credential	:	RN
Telephone Number	:	760-216-6183

Provider Enumeration Date	:	08/21/2008
Last Update Date	:	08/21/2008

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Directions to “SILVER OAK COUNTRY ESTATES ” Practice Location

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