Healthcare Provider Details

I. General information

NPI: 1164499810
Provider Name (Legal Business Name): BRIERWOOD TERRACE VENTURA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 04/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4904 TELEGRAPH RD
VENTURA CA
93003-4109
US

IV. Provider business mailing address

4904 TELEGRAPH RD
VENTURA CA
93003-4109
US

V. Phone/Fax

Practice location:
  • Phone: 805-642-4101
  • Fax: 805-642-0156
Mailing address:
  • Phone: 805-642-4101
  • Fax: 805-642-0156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number050000072
License Number StateCA

VIII. Authorized Official

Name: MR. BRETT WATSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 805-642-4101