Provider Demographics
NPI:1457554339
Name:THOMAS E MULLEN
Entity Type:Organization
Organization Name:THOMAS E MULLEN
Other - Org Name:ALDERSON CONVALESCENT HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-662-9161
Mailing Address - Street 1:124 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-3137
Mailing Address - Country:US
Mailing Address - Phone:530-662-9161
Mailing Address - Fax:530-662-9208
Practice Address - Street 1:124 WALNUT ST
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-3137
Practice Address - Country:US
Practice Address - Phone:530-662-9161
Practice Address - Fax:530-662-9208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100000155314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA055438Medicare ID - Type Unspecified