Provider Demographics
NPI:1992876767
Name:COMMUNITY MEMORIAL HEALTH SYSTEM
Entity type:Organization
Organization Name:COMMUNITY MEMORIAL HEALTH SYSTEM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ZDEBLICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-652-5001
Mailing Address - Street 1:147 N BRENT ST
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-2809
Mailing Address - Country:US
Mailing Address - Phone:805-652-5011
Mailing Address - Fax:805-585-3007
Practice Address - Street 1:1306 MARICOPA HWY
Practice Address - Street 2:
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023-3131
Practice Address - Country:US
Practice Address - Phone:805-646-1401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY MEMORIAL HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-13
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05Z334OtherMEDICARE OSCAR SWING BED
CAZZZA5603ZOtherBLUE SHIELD
CAZZZA5609ZOtherBLUE SHIELD PROVIDER NO
CA050394OtherBLUE CROSS PROVIDER NO
CAHSC30046LMedicaid
CAHSP40046LMedicaid
CAZZZ53994ZOtherBLUE SHIELD
CA=========OtherTAX IDENTIFICATION NUMBER
CA05Z334Medicare Oscar/Certification
CAZZZA5603ZOtherBLUE SHIELD
CAHSC30046LMedicaid
CAHSP40046LMedicaid