Provider Demographics
NPI:1386602613
Name:SHERWOOD OAKS ENTERPRISES, INC.
Entity type:Organization
Organization Name:SHERWOOD OAKS ENTERPRISES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:C
Authorized Official - Last Name:REDING
Authorized Official - Suffix:
Authorized Official - Credentials:NURSING HOME ADMIN
Authorized Official - Phone:707-964-6333
Mailing Address - Street 1:130 DANA ST
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:CA
Mailing Address - Zip Code:95437-4506
Mailing Address - Country:US
Mailing Address - Phone:707-964-6333
Mailing Address - Fax:707-964-1596
Practice Address - Street 1:130 DANA ST
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437-4506
Practice Address - Country:US
Practice Address - Phone:707-964-6333
Practice Address - Fax:707-964-1596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR06483HMedicaid
CA05-6483Medicare ID - Type UnspecifiedPROVIDER NUMBER