Organization
VAST OCEANSIDE ELDERLY CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DANIEL LEAVITT (ADMINISTRATOR)
(760) 807-8585
Entity
Organization
Contact information
Practice address
452 FOUSSAT RD, OCEANSIDE, CA 92054-4709
(760) 529-9257
(760) 529-9257
Mailing address
452 FOUSSAT RD, OCEANSIDE, CA 92054-4709
(760) 529-9257
(760) 529-9257
Taxonomy
Speciality
Code
Description
License number
State
251T00000X
PACE Provider Organization
Primary
374603403
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
374603403
CDSS
CA
Enumeration date
11/30/2017
Last updated
11/30/2017
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