Provider Demographics
NPI:1447643135
Name:MESA CARE
Entity type:Organization
Organization Name:MESA CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VALENTIA
Authorized Official - Middle Name:
Authorized Official - Last Name:POLUNETS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:805-965-2428
Mailing Address - Street 1:2424 CALLE SORIA
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93109-1144
Mailing Address - Country:US
Mailing Address - Phone:805-965-2428
Mailing Address - Fax:805-965-6549
Practice Address - Street 1:2424 CALLE SORIA
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93109-1144
Practice Address - Country:US
Practice Address - Phone:805-965-2428
Practice Address - Fax:805-965-6549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA425801158310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility