Healthcare Provider Details

I. General information

NPI: 1538652896
Provider Name (Legal Business Name): KHEPERA HOUSE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2018
Last Update Date: 06/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 W HARRISON AVE
VENTURA CA
93001-5825
US

IV. Provider business mailing address

330 N VENTURA AVE
VENTURA CA
93001-1937
US

V. Phone/Fax

Practice location:
  • Phone: 805-653-2596
  • Fax: 805-648-9762
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number560004EN
License Number StateCA

VIII. Authorized Official

Name: MR. MIKLOS BAER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 805-653-2596