Provider Demographics
NPI:1821447665
Name:OCEAN BREEZE RETIREMENT VILLA
Entity Type:Organization
Organization Name:OCEAN BREEZE RETIREMENT VILLA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BAYDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-649-9964
Mailing Address - Street 1:93 AVENIDA DESCANSO
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-6041
Mailing Address - Country:US
Mailing Address - Phone:919-649-9964
Mailing Address - Fax:760-231-9247
Practice Address - Street 1:93 AVENIDA DESCANSO
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92057-6041
Practice Address - Country:US
Practice Address - Phone:919-649-9964
Practice Address - Fax:760-231-9247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-10
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374603682310400000X, 311500000X, 320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities