Provider Demographics
NPI:1376998401
Name:CENTRAL COAST HOME HEALTH, INC.
Entity Type:Organization
Organization Name:CENTRAL COAST HOME HEALTH, INC.
Other - Org Name:PHARMA 101
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-543-2244
Mailing Address - Street 1:253 GRANADA DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-7340
Mailing Address - Country:US
Mailing Address - Phone:805-540-2780
Mailing Address - Fax:805-540-2158
Practice Address - Street 1:243 GRANADA DR STE A
Practice Address - Street 2:SUITE A
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-7336
Practice Address - Country:US
Practice Address - Phone:805-540-2780
Practice Address - Fax:805-540-2158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-26
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0003X
CA542523336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2159768OtherPK