# OAK FENCE SENIOR LIVING LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** OAK FENCE SENIOR LIVING LLC
- **Other names:** Apple Valley Congregate Living Health Facility
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1013674472
- **Legal business name:** OAK FENCE SENIOR LIVING LLC
- **Authorized official:** THAN T AYE (OWNER)
- **Authorized official phone:** (909) 967-1872

## Contact information

- **Practice address:** 20135 ONEIDA RD, APPLE VALLEY, CA 92307-5207
- **Practice address phone:** (909) 967-1872
- **Mailing address:** 6067 OAK FENCE LN, LANCASTER, CA 93536-1795
- **Mailing address phone:** (909) 967-1872

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | — | Yes |

## Other

- **Enumeration date:** 11/19/2021
- **Last updated:** 03/22/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1013674472 | — | CA |
| 05 | — | 1497140222 | — | CA |
| 01 | — | 550005416 | DEPARTMENT OF PUBLIC HEALTH | CA |