MEDICARE: VTC ENTERPRISES

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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LTC60512F	OTHER	CA	MEDI-CAL PROVIDER #

General Provider Information

NPI Number	:	1912126988
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VTC ENTERPRISES

Provider Business Mailing Address
First Line	:	PO BOX 1187
Second Line	:
City	:	SANTA MARIA
State	:	CA
Zip	:	93456-1187
Country	:	US
Telephone Number	:	805-735-3428
Fax Number	:	805-737-4323

Provider Business Practice Location Address
First Line	:	2445 A ST
Second Line	:
City	:	SANTA MARIA
State	:	CA
Zip	:	93455
Country	:	US
Telephone Number	:	805-928-5000
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JASON TELANDER
Credential	:
Telephone Number	:	805-928-5000

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	04/24/2025

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Directions to “VTC ENTERPRISES ” Practice Location

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