MEDICARE: ATASCADERO CHRISTIAN 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	314000000X	Skilled Nursing Facility	050000028	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	050000028	OTHER	CA	FACILITY LICENSE NUMBER

General Provider Information

NPI Number	:	1588958466
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATASCADERO CHRISTIAN HOME INC

Provider Business Mailing Address
First Line	:	8455 SANTA ROSA RD
Second Line	:
City	:	ATASCADERO
State	:	CA
Zip	:	93422-4946
Country	:	US
Telephone Number	:	805-466-0281
Fax Number	:	805-466-9714

Provider Business Practice Location Address
First Line	:	8455 SANTA ROSA RD
Second Line	:
City	:	ATASCADERO
State	:	CA
Zip	:	93422-4946
Country	:	US
Telephone Number	:	805-466-0281
Fax Number	:	805-466-9714

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. WILLIAM MOHR
Credential	:
Telephone Number	:	805-466-0281

Provider Enumeration Date	:	06/08/2011
Last Update Date	:	06/08/2011

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