MEDICARE: SONOMA OAK TREE HOME RCFE LLC

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

General Provider Information

NPI Number	:	1639009517
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SONOMA OAK TREE HOME RCFE LLC

Provider Business Mailing Address
First Line	:	425 ARBOR AVE
Second Line	:
City	:	SONOMA
State	:	CA
Zip	:	95476-4501
Country	:	US
Telephone Number	:	707-996-4706
Fax Number	:

Provider Business Practice Location Address
First Line	:	425 ARBOR AVE
Second Line	:
City	:	SONOMA
State	:	CA
Zip	:	95476-4501
Country	:	US
Telephone Number	:	707-996-4706
Fax Number	:

Authorized Official
Title or Position	:	LICENSEE
Name	:	DINA BURK
Credential	:
Telephone Number	:	925-360-1827

Provider Enumeration Date	:	05/21/2026
Last Update Date	:	05/21/2026

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