MEDICARE: ATASCADERO CHRISTIAN HOME

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	401700013	CA

General Provider Information

NPI Number	:	1811280662
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATASCADERO CHRISTIAN HOME

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	:	ADMINISTRATOR
Name	:	MR. WILLIAM MOHR
Credential	:
Telephone Number	:	805-466-0281

Provider Enumeration Date	:	05/25/2011
Last Update Date	:	05/25/2011

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