MEDICARE: OAK COTTAGE OPERATOR, 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	425801969	CA

General Provider Information

NPI Number	:	1841677176
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OAK COTTAGE OPERATOR, LLC

Provider Business Mailing Address
First Line	:	1820 DE LA VINA ST
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93101-2815
Country	:	US
Telephone Number	:	805-456-7272
Fax Number	:

Provider Business Practice Location Address
First Line	:	1820 DE LA VINA ST
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93101-2815
Country	:	US
Telephone Number	:	805-456-7272
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	JOE FRANKEN
Credential	:
Telephone Number	:	805-456-7272

Provider Enumeration Date	:	05/06/2015
Last Update Date	:	05/22/2015

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