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General NPI Number Information
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NPI Number | 1568840379
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Entity Type | Organization
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Legal Business Name | CASA MARINA AT NORTHRIDGE, INC.
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Dates
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Enumeration Date | 05/13/2015
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Last Update Date | 05/13/2015
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Provider Practice Location Address
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Address Line | 17029 ROMAR ST
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City | NORTHRIDGE
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State | CA
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Zip | 91325-1640
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Country | US
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Telephone | 818-349-3011
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Fax | 818-772-4240
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Provider Business Mailing Address
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Address Line | 17029 ROMAR ST
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City | NORTHRIDGE
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State | CA
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Zip | 91325-1640
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Country | US
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Telephone | 818-349-3011
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Fax | 818-772-4240
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. OLGA MARINA ALONZO
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Credential |
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Telephone | 818-554-3202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 197605786
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License Number State | CA
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