Deer Tail Senior Lving, Inc.

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

DEER TAIL SENIOR LVING, INC.

Doing business as

Vintage Faire Residential

Practice address

3620 Dale Rd Ste a
Modesto, CA 95356-0598

Phone

(209) 524-1798

NPI assigned

Oct 25, 2024

Last updated

Jan 30, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Soon Burnam

Title

Secretary

Phone

(949) 540-1249

Specialties & licenses 1

Addresses

Other names 1

• Vintage Faire Residential Doing business as

Tax ID family

Deer Tail Senior Lving Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Vintage Court Healthcare, Inc.

  • Skilled Nursing Facility
  • Modesto, CA
  • NPI 1104648757
  NPD tax ID

Locations

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

{
    "created_epoch": "1729814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738195200000",
    "number": "1013739663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3620 DALE RD STE A",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953560598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3620 DALE RD STE A",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953560598",
            "telephone_number": "209-524-1798"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEER TAIL SENIOR LVING, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-25",
        "last_updated": "2025-01-30",
        "certification_date": "2025-01-30",
        "status": "A",
        "authorized_official_last_name": "BURNAM",
        "authorized_official_first_name": "SOON",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "949-540-1249"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vintage Faire Residential",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brianna Decoteau
• Joselyn Arandia Deculing, NURSE PRACTITIONER
• Christopher Brandon Deen
• Danielle B Deen
• Deep Wellness Center Child & Family Inc
• Steven Deford, M.D.
• Quentin Michael Deforest, B.A.
• Sean Kirby Degmetich, STUDENT
• John Benjamin Degraft-Johnson, M.D.,
• Bomnara Degroot, FNP

• Assisted Living Facility in Modesto, CA
• Providers in Modesto, CA by specialty
• Assisted Living Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2025; 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.