Basic Information
Provider Information | |||||||||
NPI: | 1225263262 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | SANTA BARBARA COTTAGE HOSPITAL | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 689 | ||||||||
Address2: | C/O FINANCE DEPARTMENT | ||||||||
City: | SANTA BARBARA | ||||||||
State: | CA | ||||||||
PostalCode: | 931020689 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8058798964 | ||||||||
FaxNumber: | 8058798945 | ||||||||
Practice Location | |||||||||
Address1: | 1621 GRAND AVENUE | ||||||||
Address2: | VILLA RIVIERA | ||||||||
City: | SANTA BARBARA | ||||||||
State: | CA | ||||||||
PostalCode: | 93102 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8055685840 | ||||||||
FaxNumber: | 8055685844 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/20/2009 | ||||||||
LastUpdateDate: | 05/20/2009 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | BRICHER | ||||||||
AuthorizedOfficialFirstName: | JOAN | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | SR. VP FINANCE/CFO | ||||||||
AuthorizedOfficialTelephone: | 8058798964 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MRS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | 425801016 | CA | Y |   | Nursing & Custodial Care Facilities | Assisted Living Facility |   |
ID Information
ID | Type | State | Issuer | Description | ZZT30396F | 05 | CA |   | MEDICAID |