Healthcare Provider Details

I. General information

NPI: 1215924725
Provider Name (Legal Business Name): CAMARILLO COMMUNITY CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 02/17/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 GRANADA ST
CAMARILLO CA
93010-7715
US

IV. Provider business mailing address

205 GRANADA ST
CAMARILLO CA
93010-7715
US

V. Phone/Fax

Practice location:
  • Phone: 805-482-9805
  • Fax: 805-388-8242
Mailing address:
  • Phone: 805-482-9805
  • Fax: 805-388-8242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number050000087
License Number StateCA

VIII. Authorized Official

Name: MS. SOON E. BURNAM
Title or Position: AUTHORIZED AGENT
Credential:
Phone: 949-540-1249