Provider Demographics
NPI:1629066071
Name:COASTAL LLC
Entity Type:Organization
Organization Name:COASTAL LLC
Other - Org Name:VINEYARD HILLS HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-474-7010
Mailing Address - Street 1:290 HEATHER CT
Mailing Address - Street 2:
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-9738
Mailing Address - Country:US
Mailing Address - Phone:805-434-3035
Mailing Address - Fax:805-434-3065
Practice Address - Street 1:290 HEATHER CT
Practice Address - Street 2:
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-9738
Practice Address - Country:US
Practice Address - Phone:805-434-3035
Practice Address - Fax:805-434-3065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA050000125314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC55220GMedicaid
CA555220Medicare Oscar/Certification