Healthcare Provider Details

I. General information

NPI: 1386595858
Provider Name (Legal Business Name): CONGREGATION OF EUNOIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2026
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

461 S EVERGREEN DR
VENTURA CA
93003-4507
US

IV. Provider business mailing address

461 S EVERGREEN DR
VENTURA CA
93003-4507
US

V. Phone/Fax

Practice location:
  • Phone: 805-248-8652
  • Fax:
Mailing address:
  • Phone: 805-248-8652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374K00000X
TaxonomyReligious Nonmedical Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SHAWN HITTLE
Title or Position: AUTHORIZED REPRESENTITIVE
Credential:
Phone: 805-248-8652