Provider Demographics
NPI:1013007897
Name:SAN LUIS OBISPO COUNTY CCS
Entity Type:Organization
Organization Name:SAN LUIS OBISPO COUNTY CCS
Other - Org Name:OCEANO MEDICAL THERAPY UNIT
Other - Org Type:Other Name
Authorized Official - Title/Position:SUPERVISING THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:FREILER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-226-3270
Mailing Address - Street 1:1510 19TH ST
Mailing Address - Street 2:
Mailing Address - City:OCEANO
Mailing Address - State:CA
Mailing Address - Zip Code:93445-9301
Mailing Address - Country:US
Mailing Address - Phone:805-473-7137
Mailing Address - Fax:805-473-7118
Practice Address - Street 1:1510 19TH ST
Practice Address - Street 2:
Practice Address - City:OCEANO
Practice Address - State:CA
Practice Address - Zip Code:93445-9301
Practice Address - Country:US
Practice Address - Phone:805-473-7137
Practice Address - Fax:805-473-7118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation