Provider Demographics
NPI:1912454851
Name:SIMI VALLEY HEALTHCARE CENTER LLC
Entity Type:Organization
Organization Name:SIMI VALLEY HEALTHCARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLORZANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-836-9397
Mailing Address - Street 1:5270 E LOS ANGELES AVE
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-4137
Mailing Address - Country:US
Mailing Address - Phone:805-522-9155
Mailing Address - Fax:805-581-3879
Practice Address - Street 1:513 S MYRTLE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-6154
Practice Address - Country:US
Practice Address - Phone:626-658-7344
Practice Address - Fax:323-488-9274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA050000069314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC55701FMedicaid
CA555701Medicare Oscar/Certification