Provider Demographics
NPI:1639497431
Name:VETERANS HOME OF CA VENTURA
Entity Type:Organization
Organization Name:VETERANS HOME OF CA VENTURA
Other - Org Name:CALIFORNIA DEPARTMENT OF VETERANS AFFAIRS
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROULSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-659-7540
Mailing Address - Street 1:10900 TELEPHONE RD
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93004-1870
Mailing Address - Country:US
Mailing Address - Phone:805-659-7500
Mailing Address - Fax:805-659-7559
Practice Address - Street 1:10900 TELEPHONE RD
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93004-1870
Practice Address - Country:US
Practice Address - Phone:805-659-7500
Practice Address - Fax:805-659-7559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-04
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA565801637310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility