Basic Information
| Provider Information | |||||||||
| NPI: | 1225010994 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SIMI VALLEY HOSPITAL AND HEALTH CARE SERVICES | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ADVENTIST HEALTH/HOME CARE SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2975 N. SYCAMORE DRIVE | ||||||||
| Address2: | |||||||||
| City: | SIMI VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8059556000 | ||||||||
| FaxNumber: | 8055260837 | ||||||||
| Practice Location | |||||||||
| Address1: | 1850 HEYWOOD ST | ||||||||
| Address2: | |||||||||
| City: | SIMI VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930653430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055268190 | ||||||||
| FaxNumber: | 8055264690 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2005 | ||||||||
| LastUpdateDate: | 07/24/2019 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BEAMAN | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | VP FINANCE/CFO | ||||||||
| AuthorizedOfficialTelephone: | 8059556202 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ADVENTIST HEALTH SYSTEM/WEST | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 050000004 | CA | Y | Agencies | Home Health |
No ID Information.