Provider Demographics
NPI:1225488703
Name:SIERRA SALEM CHRISTIAN HOMES, INC,
Entity Type:Organization
Organization Name:SIERRA SALEM CHRISTIAN HOMES, INC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JERALD
Authorized Official - Middle Name:P
Authorized Official - Last Name:PASMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-404-4749
Mailing Address - Street 1:2414 KIRKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-2282
Mailing Address - Country:US
Mailing Address - Phone:209-408-8289
Mailing Address - Fax:209-343-3952
Practice Address - Street 1:2414 KIRKWOOD AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-2282
Practice Address - Country:US
Practice Address - Phone:209-408-8289
Practice Address - Fax:209-343-3952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities