Provider Demographics
NPI:1558498683
Name:EPIPHANY CARE HOMES INC
Entity Type:Organization
Organization Name:EPIPHANY CARE HOMES INC
Other - Org Name:BEACHCOMBER HOME ICF/DD-N
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:STEINORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-485-8111
Mailing Address - Street 1:1331 DORIS AVE
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-4409
Mailing Address - Country:US
Mailing Address - Phone:805-485-8111
Mailing Address - Fax:805-485-8170
Practice Address - Street 1:3224 WILMOT ST
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-2656
Practice Address - Country:US
Practice Address - Phone:805-485-8111
Practice Address - Fax:805-485-8170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC80371FMedicaid