Provider Demographics
NPI:1104363795
Name:SENIOR COAST LIVING, LLC
Entity Type:Organization
Organization Name:SENIOR COAST LIVING, LLC
Other - Org Name:COASTAL INJURY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIANNA
Authorized Official - Middle Name:Z
Authorized Official - Last Name:REUBEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-244-9405
Mailing Address - Street 1:8780 ELDEN STREET
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3211
Mailing Address - Country:US
Mailing Address - Phone:858-946-3100
Mailing Address - Fax:619-432-6723
Practice Address - Street 1:8780 ELDEN STREET
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3211
Practice Address - Country:US
Practice Address - Phone:949-244-9405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-20
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility