Provider Demographics
NPI:1326385907
Name:OAK PARK MANOR OPERATOR, LLC
Entity type:Organization
Organization Name:OAK PARK MANOR OPERATOR, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OF FINANCIAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:MELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CADABES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-273-8900
Mailing Address - Street 1:4250 PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-3369
Mailing Address - Country:US
Mailing Address - Phone:818-273-8900
Mailing Address - Fax:818-273-8910
Practice Address - Street 1:501 S COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-5527
Practice Address - Country:US
Practice Address - Phone:909-626-0117
Practice Address - Fax:909-625-1654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-15
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility