Provider Demographics
NPI:1245201284
Name:RURAL HAVEN
Entity Type:Organization
Organization Name:RURAL HAVEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CFO
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ELBANOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-525-0305
Mailing Address - Street 1:715 E SANTA PAULA ST
Mailing Address - Street 2:
Mailing Address - City:SANTA PAULA
Mailing Address - State:CA
Mailing Address - Zip Code:93060-2063
Mailing Address - Country:US
Mailing Address - Phone:805-525-0305
Mailing Address - Fax:805-525-7776
Practice Address - Street 1:431 SARATOGA ST
Practice Address - Street 2:
Practice Address - City:FILLMORE
Practice Address - State:CA
Practice Address - Zip Code:93015-1531
Practice Address - Country:US
Practice Address - Phone:805-524-4003
Practice Address - Fax:805-525-4003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-28
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA050000507315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC60872FMedicaid