MEDICARE: OAK PARK HEALTH CARE CENTER

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	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1376128629
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OAK PARK HEALTH CARE CENTER

Provider Business Mailing Address
First Line	:	2740 N CALIFORNIA ST # CA
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95204-5529
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2740 N CALIFORNIA ST # CA
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95204-5529
Country	:	US
Telephone Number	:	209-466-3522
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JERRY WELLS
Credential	:
Telephone Number	:	209-466-3522

Provider Enumeration Date	:	03/17/2021
Last Update Date	:	03/18/2021

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Directions to “OAK PARK HEALTH CARE CENTER ” Practice Location

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