MEDICARE: CATHEDRAL PIONEER CHURCH HOMES NO TWO

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	100000072	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518962893
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CATHEDRAL PIONEER CHURCH HOMES NO TWO

Provider Business Mailing Address
First Line	:	415 P ST
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95814-5300
Country	:	US
Telephone Number	:	916-442-4906
Fax Number	:	916-442-8665

Provider Business Practice Location Address
First Line	:	415 P ST
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95814-5300
Country	:	US
Telephone Number	:	916-442-4906
Fax Number	:	916-442-8665

Authorized Official
Title or Position	:	V.P. OF OPERATIONS
Name	:	STUART HARTMAN
Credential	:
Telephone Number	:	562-257-5100

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	09/16/2014

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Directions to “CATHEDRAL PIONEER CHURCH HOMES NO TWO ” Practice Location

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