Basic Information
| Provider Information | |||||||||
| NPI: | 1295957835 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VENTURA COUNTY MEDICAL CENTER ASSESSMENT UNIT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 S VICTORIA AVE # L4615 | ||||||||
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| City: | VENTURA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930090003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056775210 | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 N. HILLMONT AVE. | ||||||||
| Address2: | A & R UNIT | ||||||||
| City: | VENTURA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056526212 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2007 | ||||||||
| LastUpdateDate: | 01/16/2019 | ||||||||
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| AuthorizedOfficialLastName: | MILSTIEN | ||||||||
| AuthorizedOfficialFirstName: | KIM | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF DEPUTY DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8056526058 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 050000032 | CA | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 0000056BS | 05 | CA | MEDICAID |