Provider Demographics
NPI:1265481162
Name:ATASCADERO CHRISTIAN HOME
Entity Type:Organization
Organization Name:ATASCADERO CHRISTIAN HOME
Other - Org Name:COUNTRY CARE CONVALESCENT HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-466-0281
Mailing Address - Street 1:14900 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-6417
Mailing Address - Country:US
Mailing Address - Phone:805-466-0282
Mailing Address - Fax:805-438-4405
Practice Address - Street 1:14900 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-6417
Practice Address - Country:US
Practice Address - Phone:805-466-0282
Practice Address - Fax:805-438-4405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA050000028314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA400590475Medicaid
CA400590475Medicaid