Provider Demographics
NPI:1629134051
Name:VENTURA COUNTY NON-EMERGENCY MEDICAL TRANSPORTATION
Entity Type:Organization
Organization Name:VENTURA COUNTY NON-EMERGENCY MEDICAL TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAGAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-231-3995
Mailing Address - Street 1:4221 E MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-8285
Mailing Address - Country:US
Mailing Address - Phone:805-650-1070
Mailing Address - Fax:
Practice Address - Street 1:4221 E MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-8285
Practice Address - Country:US
Practice Address - Phone:805-650-1070
Practice Address - Fax:805-650-1191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0810910343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTN01216FMedicaid