Healthcare Provider Details

I. General information

NPI: 1720086077
Provider Name (Legal Business Name): SOLVANG LUTHERAN HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 07/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

636 ATTERDAG RD
SOLVANG CA
93463-2604
US

IV. Provider business mailing address

636 ATTERDAG RD
SOLVANG CA
93463-2604
US

V. Phone/Fax

Practice location:
  • Phone: 805-688-3263
  • Fax: 805-688-8574
Mailing address:
  • Phone: 805-688-3263
  • Fax: 805-688-8574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0500058
License Number StateCA

VIII. Authorized Official

Name: MR. CHRISTOPHER WARD PARKER
Title or Position: ADMINISTRATOR
Credential:
Phone: 805-688-3263