Healthcare Provider Details

I. General information

NPI: 1093990756
Provider Name (Legal Business Name): VENTURA COUNTY BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2007
Last Update Date: 12/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 E LOS ANGELES AVE
SIMI VALLEY CA
93065-3940
US

IV. Provider business mailing address

1453 SWANSEA AVE
VENTURA CA
93004-2916
US

V. Phone/Fax

Practice location:
  • Phone: 805-577-0830
  • Fax:
Mailing address:
  • Phone: 805-659-1725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number483625
License Number StateCA

VIII. Authorized Official

Name: MRS. JEANNE A PILGRAM
Title or Position: RN LL
Credential: RN
Phone: 805-577-0830