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General NPI Number Information
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NPI Number | 1770819021
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Entity Type | Organization
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Legal Business Name | CASA SAN MIGUEL, LLC
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Dates
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Enumeration Date | 10/21/2009
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Last Update Date | 10/21/2009
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Provider Practice Location Address
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Address Line | 1403 SAN MIGUEL AVE.
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City | SANTA BARBARA
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State | CA
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Zip | 73109
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Country | US
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Telephone | 805-963-1214
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Fax |
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Provider Business Mailing Address
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Address Line | 1403 SAN MIGUEL AVE.
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City | SANTA BARBARA
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State | CA
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Zip | 73109
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Country | US
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Telephone | 805-963-1214
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Fax | 805-963-9087
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | EKATERINA V. ZAMYATINA
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Credential |
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Telephone | 805-963-1214
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 425801626
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License Number State | CA
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