Provider Demographics
NPI:1598064008
Name:COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST, INC
Entity Type:Organization
Organization Name:COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST, INC
Other - Org Name:COMMUNITY HEALTH CENTERS-ARROYO GRANDE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-361-8014
Mailing Address - Street 1:2050 S BLOSSER RD
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458
Mailing Address - Country:US
Mailing Address - Phone:805-361-8014
Mailing Address - Fax:805-361-8097
Practice Address - Street 1:260 STATION WAY
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-3359
Practice Address - Country:US
Practice Address - Phone:805-473-6201
Practice Address - Fax:805-473-6291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1598064008Medicaid
CA1598064008Medicaid
CA551158Medicare Oscar/Certification