Provider Demographics
NPI:1336693100
Name:EDELWEISS HOME INC.
Entity Type:Organization
Organization Name:EDELWEISS HOME INC.
Other - Org Name:EDELWEISS HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE-PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MILDRED
Authorized Official - Middle Name:
Authorized Official - Last Name:HUG-DEMONTEVERDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-284-5870
Mailing Address - Street 1:7067 ARMSTRONG RD
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93117-4035
Mailing Address - Country:US
Mailing Address - Phone:805-845-5447
Mailing Address - Fax:805-845-6020
Practice Address - Street 1:296 PEBBLE HILL DR
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93111-1917
Practice Address - Country:US
Practice Address - Phone:805-845-5559
Practice Address - Fax:805-845-6020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA425801989310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility