Provider Demographics
NPI:1326367590
Name:MARINA'S PLACE
Entity Type:Organization
Organization Name:MARINA'S PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:AIDA
Authorized Official - Middle Name:U
Authorized Official - Last Name:ESTIVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-741-9235
Mailing Address - Street 1:8553 MELVIN AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-4136
Mailing Address - Country:US
Mailing Address - Phone:818-341-3549
Mailing Address - Fax:818-341-3549
Practice Address - Street 1:8553 MELVIN AVE
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-4136
Practice Address - Country:US
Practice Address - Phone:818-341-3549
Practice Address - Fax:818-341-3549
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE COTTAGE - ALTERNATIVE LIVING HEALTH FACILITIES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA222016315D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient