Provider Demographics
NPI:1720086077
Name:SOLVANG LUTHERAN HOME, INC.
Entity type:Organization
Organization Name:SOLVANG LUTHERAN HOME, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:WARD
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-688-3263
Mailing Address - Street 1:636 ATTERDAG RD
Mailing Address - Street 2:
Mailing Address - City:SOLVANG
Mailing Address - State:CA
Mailing Address - Zip Code:93463-2604
Mailing Address - Country:US
Mailing Address - Phone:805-688-3263
Mailing Address - Fax:805-688-8574
Practice Address - Street 1:636 ATTERDAG RD
Practice Address - Street 2:
Practice Address - City:SOLVANG
Practice Address - State:CA
Practice Address - Zip Code:93463-2604
Practice Address - Country:US
Practice Address - Phone:805-688-3263
Practice Address - Fax:805-688-8574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0500058314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT06353FOtherMEDI-CAL PROVIDER #
CAZZT06353FOtherMEDI-CAL PROVIDER #