Provider Demographics
NPI:1710951652
Name:MJV HEALTH CARE CORP
Entity Type:Organization
Organization Name:MJV HEALTH CARE CORP
Other - Org Name:DBA - OUR LADY OF FATIMA CHILDRENS HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASST. ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:A
Authorized Official - Last Name:VELASCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-487-9757
Mailing Address - Street 1:981 GILL AVE
Mailing Address - Street 2:
Mailing Address - City:PORT HUENEME
Mailing Address - State:CA
Mailing Address - Zip Code:93041
Mailing Address - Country:US
Mailing Address - Phone:805-487-7953
Mailing Address - Fax:805-487-9757
Practice Address - Street 1:981 GILL AVE
Practice Address - Street 2:
Practice Address - City:PORT HUENEME
Practice Address - State:CA
Practice Address - Zip Code:93041
Practice Address - Country:US
Practice Address - Phone:805-487-7953
Practice Address - Fax:805-487-9757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA050000346315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC60654Medicaid