Healthcare Provider Details

I. General information

NPI: 1710951652
Provider Name (Legal Business Name): MJV HEALTH CARE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 11/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

981 GILL AVE
PORT HUENEME CA
93041
US

IV. Provider business mailing address

981 GILL AVE
PORT HUENEME CA
93041
US

V. Phone/Fax

Practice location:
  • Phone: 805-487-7953
  • Fax: 805-487-9757
Mailing address:
  • Phone: 805-487-7953
  • Fax: 805-487-9757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number050000346
License Number StateCA

VIII. Authorized Official

Name: NORMA A. VELASCO
Title or Position: ASST. ADMINISTRATOR
Credential:
Phone: 805-487-9757