MEDICARE: ABUNDANT CARE

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	425800484	CA

General Provider Information

NPI Number	:	1467694943
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABUNDANT CARE

Provider Business Mailing Address
First Line	:	5506 SOMERSET DR
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93111
Country	:	US
Telephone Number	:	805-681-1937
Fax Number	:	805-681-9739

Provider Business Practice Location Address
First Line	:	5506 SOMERSET DR
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93111
Country	:	US
Telephone Number	:	805-681-1937
Fax Number	:	805-681-9739

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. TIMOTHY PRYKO
Credential	:	LVN
Telephone Number	:	805-689-6900

Provider Enumeration Date	:	03/31/2009
Last Update Date	:	03/31/2009

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