Provider Demographics
NPI:1669696837
Name:OAK HOUSE CORP
Entity type:Organization
Organization Name:OAK HOUSE CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-721-9699
Mailing Address - Street 1:7919 OAK AVE
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-2512
Mailing Address - Country:US
Mailing Address - Phone:916-721-9699
Mailing Address - Fax:916-721-5302
Practice Address - Street 1:7919 OAK AVE
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-2512
Practice Address - Country:US
Practice Address - Phone:916-721-9699
Practice Address - Fax:916-721-5302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA340013AP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3528521OtherEMPLOYER ID#
CA340013APOtherCA DEPARTMENT OF ALCOHOL