Provider Demographics
NPI:1346360930
Name:PDAP OF VENTURA COUNTY, INC.
Entity Type:Organization
Organization Name:PDAP OF VENTURA COUNTY, INC.
Other - Org Name:PALMER DRUG ABUSE PROGRAM OF VENTURA COUNTY
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:CONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:MFC
Authorized Official - Phone:805-482-1265
Mailing Address - Street 1:450 ROSEWOOD AVE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-5914
Mailing Address - Country:US
Mailing Address - Phone:805-482-1265
Mailing Address - Fax:805-389-5295
Practice Address - Street 1:450 ROSEWOOD AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-5914
Practice Address - Country:US
Practice Address - Phone:805-482-1265
Practice Address - Fax:805-389-5295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA560015BN251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5673Medicaid