Provider Demographics
NPI:1629348297
Name:OAK FENCE SENIOR LIVING
Entity Type:Organization
Organization Name:OAK FENCE SENIOR LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:THAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:AYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-967-1872
Mailing Address - Street 1:6036 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:909-967-1872
Mailing Address - Fax:667-718-8648
Practice Address - Street 1:6036 OAK FENCE LN
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-1794
Practice Address - Country:US
Practice Address - Phone:909-967-1872
Practice Address - Fax:667-718-8648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA197607406320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities