Provider Demographics
NPI:1225307317
Name:PACIFIC CENTRAL COAST HEALTH CENTERS
Entity Type:Organization
Organization Name:PACIFIC CENTRAL COAST HEALTH CENTERS
Other - Org Name:COASTAL VALLEY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-739-3108
Mailing Address - Street 1:117 W BUNNY AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-2805
Mailing Address - Country:US
Mailing Address - Phone:805-349-8514
Mailing Address - Fax:805-349-8958
Practice Address - Street 1:1510 E MAIN ST
Practice Address - Street 2:SUITE 104-C
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-4825
Practice Address - Country:US
Practice Address - Phone:805-349-8514
Practice Address - Fax:805-614-0223
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PACIFIC CENTRAL COAST HEALTH CENTERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-20
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ06481ZOtherBSCA
CAW14719Medicare PIN