Provider Demographics
NPI:1811548233
Name:CENTRAL COAST IN HOME CARE SERVICES LLC
Entity Type:Organization
Organization Name:CENTRAL COAST IN HOME CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHAFFEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-709-4077
Mailing Address - Street 1:697 AVOCET WAY
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-5571
Mailing Address - Country:US
Mailing Address - Phone:805-709-4077
Mailing Address - Fax:
Practice Address - Street 1:697 AVOCET WAY
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-5571
Practice Address - Country:US
Practice Address - Phone:805-709-4077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care