Provider Demographics
NPI:1841299286
Name:SIMI VALLEY THERAPIES WEST, INC.
Entity type:Organization
Organization Name:SIMI VALLEY THERAPIES WEST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:ILENE
Authorized Official - Last Name:ELMORE-DION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-207-6808
Mailing Address - Street 1:1390 SORREL ST
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-3357
Mailing Address - Country:US
Mailing Address - Phone:805-207-6808
Mailing Address - Fax:805-522-1009
Practice Address - Street 1:4080 LOMA VISTA RD
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003
Practice Address - Country:US
Practice Address - Phone:805-535-4400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QP2000X
CAPT21563261QP2000X
CA21563261QP2000X
261QP2000X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
W16539Medicare ID - Type Unspecified
ZZZ07167ZOtherBLUE SHEILD