Provider Demographics
NPI:1093718884
Name:CENTRAL COAST VNA & HOSPICE, INC.
Entity Type:Organization
Organization Name:CENTRAL COAST VNA & HOSPICE, INC.
Other - Org Name:CENTRAL COAST VISITING NURSE ASSOCIATION, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:NAVARRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-648-3797
Mailing Address - Street 1:5 LOWER RAGSDALE DR
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-5740
Mailing Address - Country:US
Mailing Address - Phone:831-372-6668
Mailing Address - Fax:831-648-4225
Practice Address - Street 1:5 LOWER RAGSDALE DR
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-5740
Practice Address - Country:US
Practice Address - Phone:831-372-6668
Practice Address - Fax:831-648-4225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA070000067251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR07002FMedicaid
CAZZR07002FMedicaid