Provider Demographics
NPI:1043656812
Name:MARINOAK, INC
Entity Type:Organization
Organization Name:MARINOAK, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY / VP
Authorized Official - Prefix:MRS
Authorized Official - First Name:PREMA
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:THEKKEK
Authorized Official - Suffix:
Authorized Official - Credentials:RN, NHA
Authorized Official - Phone:707-330-0000
Mailing Address - Street 1:540 W MONTE VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-3620
Mailing Address - Country:US
Mailing Address - Phone:707-449-3400
Mailing Address - Fax:707-450-0954
Practice Address - Street 1:1611 HEIGHT ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93305-2840
Practice Address - Country:US
Practice Address - Phone:661-872-2324
Practice Address - Fax:661-871-4661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility