Provider Demographics
NPI:1497140222
Name:OAK FENCE SENIOR LIVING, LLC
Entity Type:Organization
Organization Name:OAK FENCE SENIOR LIVING, LLC
Other - Org Name:OAK FENCE CONGREGATE LIVING HEALTH FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THAN
Authorized Official - Middle Name:THAN
Authorized Official - Last Name:AYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-967-1872
Mailing Address - Street 1:6067 WEST OAK FENCE LANE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536
Mailing Address - Country:US
Mailing Address - Phone:661-270-2140
Mailing Address - Fax:
Practice Address - Street 1:6067 WEST OAK FENCE LANE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536
Practice Address - Country:US
Practice Address - Phone:661-270-2140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-30
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550002982314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA550002982OtherDEPARTMENT OF PUBLIC HEALTH