Provider Demographics
NPI:1518962893
Name:CATHEDRAL PIONEER CHURCH HOMES NO TWO
Entity Type:Organization
Organization Name:CATHEDRAL PIONEER CHURCH HOMES NO TWO
Other - Org Name:PIONEER HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:V.P. OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-257-5100
Mailing Address - Street 1:415 P ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95814-5300
Mailing Address - Country:US
Mailing Address - Phone:916-442-4906
Mailing Address - Fax:916-442-8665
Practice Address - Street 1:415 P ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95814-5300
Practice Address - Country:US
Practice Address - Phone:916-442-4906
Practice Address - Fax:916-442-8665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-14
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100000072314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1518962893Medicaid
CA1518962893Medicaid