Provider Demographics
NPI:1104200773
Name:COAST VALLEY WORSHIP CENTER
Entity Type:Organization
Organization Name:COAST VALLEY WORSHIP CENTER
Other - Org Name:COAST VALLEY SUBSTANCE ABUSE TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:HAMLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:805-739-1512
Mailing Address - Street 1:1414 S MILLER ST
Mailing Address - Street 2:STE 10 AND 11
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-6923
Mailing Address - Country:US
Mailing Address - Phone:805-739-1512
Mailing Address - Fax:805-349-2855
Practice Address - Street 1:1414 S MILLER ST
Practice Address - Street 2:STE 10 AND 11
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-6923
Practice Address - Country:US
Practice Address - Phone:805-739-1512
Practice Address - Fax:805-349-2855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder