NPIMap

Organization Active NPI

Oak Fence Senior Living LLC

Doing business as Apple Valley Congregate Living Health Facility

  • Skilled Nursing Facility
  • Apple Valley, CA
National Provider Identifier
1013674472
Registry record updated Mar 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
OAK FENCE SENIOR LIVING LLC
Doing business as
Apple Valley Congregate Living Health Facility
Practice address
20135 Oneida Rd
Apple Valley, CA 92307-5207
Phone
(909) 967-1872
NPI assigned
Nov 19, 2021
Last updated
Mar 22, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
OAK FENCE SENIOR LIVING LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 22, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Than T AyeNPI 1710531801
Title
Owner
Phone
(909) 967-1872

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

20135 Oneida Rd
Apple Valley, CA 92307-5207

Mailing address

6067 Oak Fence LN
Lancaster, CA 93536-1795
Phone (909) 967-1872

Other identifiers 3

IdentifierTypeStateIssuer
1013674472MedicaidCA
1497140222MedicaidCA
550005416OtherCADEPARTMENT OF PUBLIC HEALTH

Other names 1

  • Apple Valley Congregate Living Health Facility Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Oak Fence Senior Living LLC4 organizations share this tax ID, including this one
Part of
Oak Fence Senior Living LLC

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1637280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679443200000",
    "number": "1013674472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6067 OAK FENCE LN",
            "city": "LANCASTER",
            "state": "CA",
            "postal_code": "935361795",
            "telephone_number": "909-967-1872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20135 ONEIDA RD",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "923075207",
            "telephone_number": "909-967-1872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OAK FENCE SENIOR LIVING LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OAK FENCE SENIOR LIVING LLC",
        "enumeration_date": "2021-11-19",
        "last_updated": "2023-03-22",
        "certification_date": "2023-03-09",
        "status": "A",
        "authorized_official_last_name": "AYE",
        "authorized_official_first_name": "THAN",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "909-967-1872"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1013674472",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1497140222",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPARTMENT OF PUBLIC HEALTH",
            "identifier": "550005416",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Apple Valley Congregate Living Health Facility",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Apple Valley Congregate Living Health Facility",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Apple Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.