Provider Demographics
NPI:1003165341
Name:LIVE OAK ADULT DAY SERVICES
Entity Type:Organization
Organization Name:LIVE OAK ADULT DAY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUDGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-971-9363
Mailing Address - Street 1:1147 MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-3324
Mailing Address - Country:US
Mailing Address - Phone:408-971-9363
Mailing Address - Fax:408-971-9079
Practice Address - Street 1:1147 MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-3324
Practice Address - Country:US
Practice Address - Phone:408-971-9363
Practice Address - Fax:408-971-9079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA435200743385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care