Organization
LIVE OAK REST HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NICHOLAS LEON RAY (LICENSEE)
(707) 514-6727
Entity
Organization
Contact information
Practice address
604 LIVE OAK AVE, SEBASTOPOL, CA 95472-3363
(707) 823-7277
(707) 823-5462
Mailing address
604 LIVE OAK AVE, SEBASTOPOL, CA 95472-3363
(707) 514-6727
(707) 823-5462
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
—
—
Other
Enumeration date
11/08/2022
Last updated
11/08/2022
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