Provider Demographics
NPI:1194691816
Name:OSAYI RESIDENTIAL CARE LLC
Entity type:Organization
Organization Name:OSAYI RESIDENTIAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SHONTWANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:OSAWARU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-390-5724
Mailing Address - Street 1:PO BOX 901675
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93590-1675
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:38656 LILACVIEW AVE
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-4250
Practice Address - Country:US
Practice Address - Phone:661-390-5724
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-13
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities