Provider Demographics
NPI:1114195997
Name:COASTAL HEARING SOLUTIONS, INC.
Entity Type:Organization
Organization Name:COASTAL HEARING SOLUTIONS, INC.
Other - Org Name:DBA MIRACLE EAR CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:KENNY LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:FAIRFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-544-0592
Mailing Address - Street 1:882 BOYSEN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-1311
Mailing Address - Country:US
Mailing Address - Phone:805-544-0592
Mailing Address - Fax:805-544-4642
Practice Address - Street 1:882 BOYSEN AVE
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-1311
Practice Address - Country:US
Practice Address - Phone:805-544-0592
Practice Address - Fax:805-544-4642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAH42915237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty