Provider Demographics
NPI:1376567834
Name:SOLEDAD COMMUNITY HEALTH CARE DISTRICT
Entity Type:Organization
Organization Name:SOLEDAD COMMUNITY HEALTH CARE DISTRICT
Other - Org Name:EDEN VALLEY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:PRITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-678-2462
Mailing Address - Street 1:612 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOLEDAD
Mailing Address - State:CA
Mailing Address - Zip Code:93960-2533
Mailing Address - Country:US
Mailing Address - Phone:831-678-2462
Mailing Address - Fax:831-678-1539
Practice Address - Street 1:612 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOLEDAD
Practice Address - State:CA
Practice Address - Zip Code:93960-2533
Practice Address - Country:US
Practice Address - Phone:831-678-2462
Practice Address - Fax:831-678-1539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC55538FMedicaid
555538Medicare ID - Type UnspecifiedMEDICARE FACILITY NUMBER