Provider Demographics
NPI:1922853324
Name:VENTURA HARBOR RESTAURANT ASSOCIATES INC
Entity Type:Organization
Organization Name:VENTURA HARBOR RESTAURANT ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS, CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ORESTIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-612-0202
Mailing Address - Street 1:200 N WESTLAKE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-3771
Mailing Address - Country:US
Mailing Address - Phone:805-612-0202
Mailing Address - Fax:
Practice Address - Street 1:1510 ANCHORS WAY DR
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-6282
Practice Address - Country:US
Practice Address - Phone:805-612-0202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332U00000XSuppliersHome Delivered Meals
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No174200000XOther Service ProvidersMeals