Provider Demographics
NPI:1376539130
Name:LOMPOC VALLEY MEDICAL CENTER
Entity Type:Organization
Organization Name:LOMPOC VALLEY MEDICAL CENTER
Other - Org Name:CONVALESCENT CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHENEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-737-3306
Mailing Address - Street 1:216 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-6104
Mailing Address - Country:US
Mailing Address - Phone:805-737-3367
Mailing Address - Fax:
Practice Address - Street 1:216 N 3RD ST
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-6104
Practice Address - Country:US
Practice Address - Phone:805-737-3367
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT30110FMedicaid
CAZZT40110FMedicaid
CAZZT05256GMedicaid
CAZZT40110FMedicaid