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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