Provider Demographics
NPI:1902863418
Name:AURORA VISTA DEL MAR, LLC
Entity Type:Organization
Organization Name:AURORA VISTA DEL MAR, LLC
Other - Org Name:AURORA VISTA DEL MAR, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:MAYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:KREBSBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-653-6434
Mailing Address - Street 1:801 SENECA ST
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-1411
Mailing Address - Country:US
Mailing Address - Phone:805-653-6434
Mailing Address - Fax:805-641-0429
Practice Address - Street 1:801 SENECA ST
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-1411
Practice Address - Country:US
Practice Address - Phone:805-653-6434
Practice Address - Fax:805-641-0429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSP44077HMedicaid
CAHSP34077HMedicaid
CAHSM34077HMedicaid
CAHSP44077HMedicaid