Provider Demographics
NPI:1598217416
Name:COAST VALLEY WORSHIP CENTER
Entity Type:Organization
Organization Name:COAST VALLEY WORSHIP CENTER
Other - Org Name:COAST VALLEY SUBSTANCE ABUSE TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:805-739-1512
Mailing Address - Street 1:1414 S MILLER ST
Mailing Address - Street 2:STE 10 AND 11
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-6923
Mailing Address - Country:US
Mailing Address - Phone:805-739-1512
Mailing Address - Fax:805-349-2855
Practice Address - Street 1:300 W WILLOW AVE
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-7724
Practice Address - Country:US
Practice Address - Phone:805-735-7525
Practice Address - Fax:805-737-0524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility