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Organization
OUR LADY OF GUADALUPE
Active
Organization
OUR LADY OF GUADALUPE
Active
Other names
MJV HEALTH CARE CORPORATION
Organization subpart
No
Provider details
NPI number
Authorized official
MS. NORMA VELASCO PRESIDENT (OWNER)
(805) 487-9757
Entity
Organization
Contact information
Practice address
1474 N 5TH ST, PORT HUENEME, CA 93041-2205
(805) 487-9757
(805) 487-9757
Mailing address
2311 E CHEVY CHASE DR, GLENDALE, CA 91206-1811
(805) 487-9757
(805) 487-9757
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
LTC60799F
—
CA
Enumeration date
02/15/2006
Last updated
08/22/2020
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