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OUR LADY OF GUADALUPE

Intermediate Care Facility, Mentally Retarded

Port Hueneme, California

Provider NPI: 1447224381

Organization Information:
Organization Name:  OUR LADY OF GUADALUPE


Practice Location:
1474 N 5TH ST  PORT HUENEME, CA 93041 US
Tel: 805-487-9757  Fax: --

Business Mailing Address:
  ,   
Tel: --  Fax: --


Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y315P00000XNursing & Custodial Care Facilities
Intermediate Care Facility, Mentally Retarded
CA

Other Provider Identifiers:

IssuerNumberStateType
LTC60799FCA05
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin




MENTALLY RETARDED JOBS CA - Page 1



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