Provider Demographics
NPI:1386196079
Name:ST PEREGRINE HOSPITIUM OF VENTURA INC
Entity type:Organization
Organization Name:ST PEREGRINE HOSPITIUM OF VENTURA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE VICENTE
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-383-9000
Mailing Address - Street 1:215 E DAILY DR
Mailing Address - Street 2:SUITE 15
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-5805
Mailing Address - Country:US
Mailing Address - Phone:805-383-9000
Mailing Address - Fax:877-725-7352
Practice Address - Street 1:215 E DAILY DR
Practice Address - Street 2:SUITE 15
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-5805
Practice Address - Country:US
Practice Address - Phone:805-383-9000
Practice Address - Fax:877-725-7352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based