MEDICARE: SHERWOOD OAKS ENTERPRISES, INC.

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		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386602613
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHERWOOD OAKS ENTERPRISES, INC.

Provider Business Mailing Address
First Line	:	130 DANA ST
Second Line	:
City	:	FORT BRAGG
State	:	CA
Zip	:	95437-4506
Country	:	US
Telephone Number	:	707-964-6333
Fax Number	:	707-964-1596

Provider Business Practice Location Address
First Line	:	130 DANA ST
Second Line	:
City	:	FORT BRAGG
State	:	CA
Zip	:	95437-4506
Country	:	US
Telephone Number	:	707-964-6333
Fax Number	:	707-964-1596

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. JOSEPH C. REDING
Credential	:	NURSING HOME ADMIN.
Telephone Number	:	707-964-6333

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	08/22/2020

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