Basic Information
| Provider Information | |||||||||
| NPI: | 1639245467 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OAKHURST LIVING CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 35680 WISH I AH RD | ||||||||
| Address2: | |||||||||
| City: | AUBERRY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936029615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5598552211 | ||||||||
| FaxNumber: | 5598556590 | ||||||||
| Practice Location | |||||||||
| Address1: | 40131 HIGHWAY 49 | ||||||||
| Address2: | |||||||||
| City: | OAKHURST | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936449560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596832244 | ||||||||
| FaxNumber: | 5596830220 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2006 | ||||||||
| LastUpdateDate: | 03/30/2009 | ||||||||
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| AuthorizedOfficialLastName: | HARSHMAN | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | ELLSWORTH | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5598552211 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | III | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | CA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | LTC55115G | 05 | CA | MEDICAID |