Basic Information
Provider Information | |||||||||
NPI: | 1518189158 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | VENTURA COUNTY BEHAVIORAL HEALTH | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | VENTURA COUNTY BEHAVIORAL HEALTH | ||||||||
OtherOrganizationType: | 5 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1911 WILLIAMS DR | ||||||||
Address2: | SUITE 210, BILLING DEPT | ||||||||
City: | OXNARD | ||||||||
State: | CA | ||||||||
PostalCode: | 930362612 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8059815478 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1911 WILLIAMS DRIVE | ||||||||
Address2: |   | ||||||||
City: | OXNARD | ||||||||
State: | CA | ||||||||
PostalCode: | 93036 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8059814200 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/03/2007 | ||||||||
LastUpdateDate: | 02/12/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | EGAN | ||||||||
AuthorizedOfficialFirstName: | NARCISA | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CFO | ||||||||
AuthorizedOfficialTelephone: | 8056775140 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
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 | 0000056BV | 05 | CA |   | MEDICAID |