Provider Demographics
NPI:1164499810
Name:BRIERWOOD TERRACE VENTURA INC.
Entity Type:Organization
Organization Name:BRIERWOOD TERRACE VENTURA INC.
Other - Org Name:THE VENTURAN CONVALESCENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-642-4101
Mailing Address - Street 1:4904 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-4109
Mailing Address - Country:US
Mailing Address - Phone:805-642-4101
Mailing Address - Fax:805-642-0156
Practice Address - Street 1:4904 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-4109
Practice Address - Country:US
Practice Address - Phone:805-642-4101
Practice Address - Fax:805-642-0156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-01
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA050000072314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA055566Medicare ID - Type UnspecifiedMUTUAL OF OMAHA