Provider Demographics
NPI:1770819021
Name:CASA SAN MIGUEL, LLC
Entity Type:Organization
Organization Name:CASA SAN MIGUEL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EKATERINA
Authorized Official - Middle Name:V
Authorized Official - Last Name:ZAMYATINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-963-1214
Mailing Address - Street 1:1403 SAN MIGUEL AVE.
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:73109
Mailing Address - Country:US
Mailing Address - Phone:805-963-1214
Mailing Address - Fax:805-963-9087
Practice Address - Street 1:1403 SAN MIGUEL AVE.
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:73109
Practice Address - Country:US
Practice Address - Phone:805-963-1214
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA425801626310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility