# CABRILLO CARE CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659374981
- **Authorized official:** BRYAN ROLDAN (ADMINISTRATOR)
- **Authorized official phone:** (805) 544-5100

## Contact information

- **Practice address:** 3033 AUGUSTA ST, SAN LUIS OBISPO, CA 93401-5820
- **Practice address phone:** (805) 544-5100
- **Practice address fax:** (805) 544-7209
- **Mailing address:** 3033 AUGUSTA ST, SAN LUIS OBISPO, CA 93401-5820
- **Mailing address phone:** (805) 544-5100
- **Mailing address fax:** (805) 544-7209

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | CA | Yes |

## Other

- **Enumeration date:** 05/31/2005
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | ZZT06189H | — | CA |