Healthcare Provider Details

I. General information

NPI: 1770659153
Provider Name (Legal Business Name): COMMUNITY MEMORIAL HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 08/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1306 MARICOPA HWY
OJAI CA
93023-3131
US

IV. Provider business mailing address

147 N BRENT ST
VENTURA CA
93003-2809
US

V. Phone/Fax

Practice location:
  • Phone: 805-646-1401
  • Fax: 805-585-3007
Mailing address:
  • Phone: 805-652-5036
  • Fax: 805-585-3007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GARY K WILDE
Title or Position: PRESIDENT CEO
Credential:
Phone: 805-652-5011