Healthcare Provider Details

I. General information

NPI: 1457417867
Provider Name (Legal Business Name): FRIENDS OF THE ELDERLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4221 E MAIN ST SUITE C
VENTURA CA
93003-8285
US

IV. Provider business mailing address

4221 E MAIN ST SUITE C
VENTURA CA
93003-8285
US

V. Phone/Fax

Practice location:
  • Phone: 805-650-1190
  • Fax: 805-650-1191
Mailing address:
  • Phone: 805-650-1190
  • Fax: 805-650-1191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. ANDREW SHAGAL
Title or Position: ADMINISTRATOR
Credential: DC
Phone: 805-650-1190