Provider Demographics
NPI:1649741356
Name:OAK FENCE SENIOR LIVING, LLC
Entity Type:Organization
Organization Name:OAK FENCE SENIOR LIVING, LLC
Other - Org Name:BAKERSFIELD CONGREGATE LIVING HEALTH FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
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 OAK FENCE LN
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-1794
Mailing Address - Country:US
Mailing Address - Phone:909-967-1872
Mailing Address - Fax:
Practice Address - Street 1:9701 BUCKHORN PEAK DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-8832
Practice Address - Country:US
Practice Address - Phone:909-967-1872
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-07
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1497140222Medicaid
CA1649741356Medicaid
CA550004379OtherCALIFORNIA DEPARTMENT OF PUBLIC HEALTH