Provider Demographics
NPI:1790436947
Name:CENTRAL COAST CENTER FOR INDEPENDENT LIVING (CCCIL)
Entity Type:Organization
Organization Name:CENTRAL COAST CENTER FOR INDEPENDENT LIVING (CCCIL)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:CABRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-757-2968
Mailing Address - Street 1:318 CAYYGA ST, SUITE 208
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901
Mailing Address - Country:US
Mailing Address - Phone:831-757-2968
Mailing Address - Fax:831-757-5549
Practice Address - Street 1:318 CAYYGA ST, SUITE 208
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901
Practice Address - Country:US
Practice Address - Phone:831-905-2796
Practice Address - Fax:831-757-5549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management