MEDICARE: THOMAS E MULLEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	100000155	CA

General Provider Information

NPI Number	:	1457554339
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMAS E MULLEN

Provider Business Mailing Address
First Line	:	124 WALNUT ST
Second Line	:
City	:	WOODLAND
State	:	CA
Zip	:	95695-3137
Country	:	US
Telephone Number	:	530-662-9161
Fax Number	:	530-662-9208

Provider Business Practice Location Address
First Line	:	124 WALNUT ST
Second Line	:
City	:	WOODLAND
State	:	CA
Zip	:	95695-3137
Country	:	US
Telephone Number	:	530-662-9161
Fax Number	:	530-662-9208

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	TOM MULLEN
Credential	:
Telephone Number	:	530-662-9161

Provider Enumeration Date	:	06/07/2007
Last Update Date	:	06/12/2008

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Directions to “THOMAS E MULLEN ” Practice Location

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