Provider Demographics
NPI:1609260223
Name:C&M VICTORIA LANE INC.
Entity Type:Organization
Organization Name:C&M VICTORIA LANE INC.
Other - Org Name:AT HOME IN SANTA BARBARA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-945-9137
Mailing Address - Street 1:225 N LOMITA AVE
Mailing Address - Street 2:
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-1541
Mailing Address - Country:US
Mailing Address - Phone:805-646-2402
Mailing Address - Fax:
Practice Address - Street 1:1801 BATH ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2810
Practice Address - Country:US
Practice Address - Phone:805-569-3701
Practice Address - Fax:805-569-7070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-20
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA425801552310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility