Provider Demographics
NPI:1053651372
Name:WEST COAST HEALTHCARE LLC
Entity Type:Organization
Organization Name:WEST COAST HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-270-3770
Mailing Address - Street 1:29222 RANCHO VIEJO RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-1041
Mailing Address - Country:US
Mailing Address - Phone:949-270-3770
Mailing Address - Fax:
Practice Address - Street 1:29222 RANCHO VIEJO RD
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1041
Practice Address - Country:US
Practice Address - Phone:949-270-3770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-22
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based