Provider Demographics
NPI:1790771194
Name:VETERANS HOME OF CALIFORNIA - CHULA VISTA
Entity Type:Organization
Organization Name:VETERANS HOME OF CALIFORNIA - CHULA VISTA
Other - Org Name:CALIFORNIA DEPARTMENT OF VETERANS AFFAIRS
Other - Org Type:Other Name
Authorized Official - Title/Position:ACTING ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-482-6037
Mailing Address - Street 1:700 E NAPLES CT
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-6821
Mailing Address - Country:US
Mailing Address - Phone:619-482-6010
Mailing Address - Fax:619-205-1110
Practice Address - Street 1:700 E NAPLES CT
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-6821
Practice Address - Country:US
Practice Address - Phone:619-482-6010
Practice Address - Fax:619-205-1110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-21
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374601005310400000X
CA170000836314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC55795FMedicaid
CADD4357OtherRAILROAD MEDICARE
CA555795Medicare Oscar/Certification