Provider Demographics
NPI:1396365078
Name:OCEANSIDE REST HOME INC
Entity type:Organization
Organization Name:OCEANSIDE REST HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SIERA
Authorized Official - Middle Name:
Authorized Official - Last Name:NAVASAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-822-6182
Mailing Address - Street 1:4451 SAN JOAQUIN ST
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-6024
Mailing Address - Country:US
Mailing Address - Phone:760-433-3736
Mailing Address - Fax:760-730-5226
Practice Address - Street 1:4451 SAN JOAQUIN ST
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92057-6024
Practice Address - Country:US
Practice Address - Phone:760-433-3736
Practice Address - Fax:760-730-5226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility