Basic Information
| Provider Information | |||||||||
| NPI: | 1265515118 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LOS ROBLES CARE CENTER INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | LOS ROBLES CARE CENTER | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 N MONTGOMERY ST | ||||||||
| Address2: | |||||||||
| City: | OJAI | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930232751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056468124 | ||||||||
| FaxNumber: | 8056462627 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 N MONTGOMERY ST | ||||||||
| Address2: | |||||||||
| City: | OJAI | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930232751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056468124 | ||||||||
| FaxNumber: | 8056462627 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2006 | ||||||||
| LastUpdateDate: | 03/26/2009 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | LINKOUS | ||||||||
| AuthorizedOfficialFirstName: | CLAUDE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 8056468124 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282E00000X | 050000020 | CA | Y | Hospitals | Long Term Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | LTC05861H | 05 | CA | MEDICAID |