Our Lady of Guadalupe

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

Legal business name

OUR LADY OF GUADALUPE

Practice address

1474 N 5TH St
Port Hueneme, CA 93041-2205

Phone

(805) 487-9757

Fax

(805) 487-9757

NPI assigned

Feb 15, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Norma Velasco, PRESIDENT

Title

Owner

Phone

(805) 487-9757

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• MJV HEALTH CARE CORPORATION Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 55G103

Legal name

Our Lady of Guadalupe Home

Certification status

Active

Provider type (POS)

Intermediate care facility for individuals with intellectual disabilities

Participating since

Jun 12, 1997

Last certification

Jun 11, 2025

Beds

6

Ownership / control type

Private (non-profit)

Facility address

1474 North 5th Street
Port Hueneme, CA 93041

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1139961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1447224381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2311 E CHEVY CHASE DR",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912061811",
            "telephone_number": "805-487-9757",
            "fax_number": "805-487-9757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1474 N 5TH ST",
            "city": "PORT HUENEME",
            "state": "CA",
            "postal_code": "930412205",
            "telephone_number": "805-487-9757",
            "fax_number": "805-487-9757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OUR LADY OF GUADALUPE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "VELASCO",
        "authorized_official_first_name": "NORMA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "805-487-9757",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "PRESIDENT"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC60799F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MJV HEALTH CARE CORPORATION",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Julie Nguyen
• Robert C O'Boyle, MD
• Cindy Stephany Oliva
• Antonia Maria Ortiz
• Julio Cesar Ortiz, INDEPENDENT DUTY HM
• Passages Silver Strand, LLC
• Passages Silver Strand, LLC (Passages Ventura)
• Omar A Perea, M.A.
• Tuyen T Pham, PHD
• Ida Pirali

• Intellectual Disabilities Intermediate Care Facility in Port Hueneme, CA
• Providers in Port Hueneme, CA by specialty
• Intellectual Disabilities Intermediate Care Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.