# OAK PARK HEALTHCARE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Oak Park Convalescent Hospital
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336470111
- **Authorized official:** MR. PERRY BYRON DEFOOR (OWNER)
- **Authorized official phone:** (423) 308-1845

## Contact information

- **Practice address:** 1625 OAK PARK BLVD, PLEASANT HILL, CA 94523-4487
- **Practice address phone:** (925) 935-5222
- **Practice address fax:** (925) 935-5211
- **Mailing address:** 801 BROAD ST, SUITE 300, CHATTANOOGA, TN 37402-2671
- **Mailing address phone:** (423) 308-1845
- **Mailing address fax:** (423) 398-1844

## Taxonomy

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

## Other

- **Enumeration date:** 01/19/2010
- **Last updated:** 09/08/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 055049 | TPAN | — |