Provider Demographics
NPI:1114567716
Name:DIAMOND OAK SENIOR LIVING INC
Entity Type:Organization
Organization Name:DIAMOND OAK SENIOR LIVING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOLSORA
Authorized Official - Middle Name:NUEZ
Authorized Official - Last Name:TILAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-647-7772
Mailing Address - Street 1:9841 PARTINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-6282
Mailing Address - Country:US
Mailing Address - Phone:916-647-7772
Mailing Address - Fax:916-895-2482
Practice Address - Street 1:8636 DIAMOND OAK WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-1755
Practice Address - Country:US
Practice Address - Phone:916-690-8874
Practice Address - Fax:916-895-2482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility