MEDICARE: EDELWEISS HOME INC.

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	310400000X	Assisted Living Facility	425801989	CA

General Provider Information

NPI Number	:	1336693100
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDELWEISS HOME INC.

Provider Business Mailing Address
First Line	:	7067 ARMSTRONG RD
Second Line	:
City	:	GOLETA
State	:	CA
Zip	:	93117-4035
Country	:	US
Telephone Number	:	805-845-5447
Fax Number	:	805-845-6020

Provider Business Practice Location Address
First Line	:	296 PEBBLE HILL DR
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93111-1917
Country	:	US
Telephone Number	:	805-845-5559
Fax Number	:	805-845-6020

Authorized Official
Title or Position	:	VICE-PRESIDENT/ADMINISTRATOR
Name	:	MRS. MILDRED HUG-DEMONTEVERDE
Credential	:
Telephone Number	:	805-284-5870

Provider Enumeration Date	:	08/10/2016
Last Update Date	:	08/10/2016

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