Provider Demographics
NPI:1619179355
Name:THE COTTONWOOD
Entity Type:Organization
Organization Name:THE COTTONWOOD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:FLORO
Authorized Official - Middle Name:P
Authorized Official - Last Name:CORTES
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:805-647-1353
Mailing Address - Street 1:1417 LIRIO AVE
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93004-3229
Mailing Address - Country:US
Mailing Address - Phone:805-647-1353
Mailing Address - Fax:
Practice Address - Street 1:1417 LIRIO AVE
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93004-3229
Practice Address - Country:US
Practice Address - Phone:805-647-1353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility