Provider Demographics
NPI:1689825473
Name:CAMARILLO SKILLED HOME HEALTH LLC
Entity Type:Organization
Organization Name:CAMARILLO SKILLED HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEAN MARIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SOLLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-987-2888
Mailing Address - Street 1:450 ROSEWOOD AVE.
Mailing Address - Street 2:UNIT 213
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-5914
Mailing Address - Country:US
Mailing Address - Phone:805-987-2888
Mailing Address - Fax:805-987-2885
Practice Address - Street 1:450 ROSEWOOD AVE STE 213
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-5914
Practice Address - Country:US
Practice Address - Phone:805-987-2888
Practice Address - Fax:805-987-2885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-10
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA059246Medicaid
CA059246Medicaid