Provider Demographics
NPI:1578754594
Name:REDWOOD COAST HEARING CENTER, INC.
Entity Type:Organization
Organization Name:REDWOOD COAST HEARING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:GAGER
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:707-464-7121
Mailing Address - Street 1:785 E WASHINGTON BLVD
Mailing Address - Street 2:SUITE 14
Mailing Address - City:CRESCENT CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95531-8343
Mailing Address - Country:US
Mailing Address - Phone:707-464-7121
Mailing Address - Fax:707-464-7151
Practice Address - Street 1:785 E WASHINGTON BLVD
Practice Address - Street 2:SUITE 14
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-8343
Practice Address - Country:US
Practice Address - Phone:707-464-7121
Practice Address - Fax:707-464-7151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHTL8265237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty