Congregational Church Retirement Community

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

030000172 Issued in CA

Legal business name

CONGREGATIONAL CHURCH RETIREMENT COMMUNITY

Doing business as

Auburn Ravine Terrace

Practice address

750 Auburn Ravine Rd
Auburn, CA 95603-3820

Phone

(530) 823-6131

Fax

(530) 823-9510

NPI assigned

Jun 14, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Peter Peabody

Title

V.P. Healthcare Operations

Phone

(562) 257-5107

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• AUBURN RAVINE TERRACE Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1118707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1233619200000",
    "number": "1083619365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 AUBURN RAVINE RD",
            "city": "AUBURN",
            "state": "CA",
            "postal_code": "956033820",
            "telephone_number": "530-823-6131",
            "fax_number": "530-823-9510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 AUBURN RAVINE RD",
            "city": "AUBURN",
            "state": "CA",
            "postal_code": "956033820",
            "telephone_number": "530-823-6131",
            "fax_number": "530-823-9510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONGREGATIONAL CHURCH RETIREMENT COMMUNITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-14",
        "last_updated": "2009-02-03",
        "status": "A",
        "authorized_official_last_name": "PEABODY",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "V.P. HEALTHCARE OPERATIONS",
        "authorized_official_telephone_number": "562-257-5107"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "030000172",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC90009F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AUBURN RAVINE TERRACE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Catherine Mary Coleman
• Jaiydyn Collier
• Leslie Anne Collins
• Colonial Healthcare, Inc.
• Heather M Colquhoun
• Desiree Coniglio, NP
• Lauren Conklin
• Charlene Ruth Conley, LCSW
• Erinn Conner-Bailey
• Jennifer Cook

• Skilled Nursing Facility in Auburn, CA
• Providers in Auburn, CA by specialty
• Skilled Nursing Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.