Provider Demographics
NPI:1215149729
Name:CRISIS PREGNANCY CENTER OF SIMI VALLEY
Entity type:Organization
Organization Name:CRISIS PREGNANCY CENTER OF SIMI VALLEY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:PASTOR
Authorized Official - Phone:805-583-3598
Mailing Address - Street 1:2650 JONES WAY
Mailing Address - Street 2:SUITE 31
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-1222
Mailing Address - Country:US
Mailing Address - Phone:805-583-3598
Mailing Address - Fax:
Practice Address - Street 1:2650 JONES WAY
Practice Address - Street 2:SUITE 31
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-1222
Practice Address - Country:US
Practice Address - Phone:805-583-3598
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACMM71140FMedicaid