Provider Demographics
NPI:1144618687
Name:COMMUNITY MEMORIAL HOSPITA
Entity Type:Organization
Organization Name:COMMUNITY MEMORIAL HOSPITA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOSPITAL PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:GHATTAS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:805-652-5068
Mailing Address - Street 1:147 N BRENT ST
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-2809
Mailing Address - Country:US
Mailing Address - Phone:805-652-5068
Mailing Address - Fax:805-652-6914
Practice Address - Street 1:727 NILE RIVER DR
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-5354
Practice Address - Country:US
Practice Address - Phone:805-223-3338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47392261Q00000X, 282N00000X, 305S00000X, 310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No282N00000XHospitalsGeneral Acute Care Hospital
No305S00000XManaged Care OrganizationsPoint of Service