Provider Demographics
NPI:1609044924
Name:CENTRAL COAST HOME HEALTH INC
Entity Type:Organization
Organization Name:CENTRAL COAST HOME HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
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:805-543-2244
Mailing Address - Fax:805-543-2224
Practice Address - Street 1:253 GRANADA DR
Practice Address - Street 2:SUITE D
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-7340
Practice Address - Country:US
Practice Address - Phone:805-543-2244
Practice Address - Fax:805-543-2224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
CA550000764251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
551604Medicare Oscar/Certification
059010Medicare Oscar/Certification