Provider Demographics
NPI:1669986410
Name:VAST OCEANSIDE ELDERLY CARE
Entity type:Organization
Organization Name:VAST OCEANSIDE ELDERLY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEAVITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-807-8585
Mailing Address - Street 1:452 FOUSSAT RD
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-4709
Mailing Address - Country:US
Mailing Address - Phone:760-529-9257
Mailing Address - Fax:760-529-9257
Practice Address - Street 1:452 FOUSSAT RD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-4709
Practice Address - Country:US
Practice Address - Phone:760-529-9257
Practice Address - Fax:760-529-9257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-30
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374603403251T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA374603403OtherCDSS