Provider Demographics
NPI:1881035079
Name:PACIFIC CENTRAL COAST HEALTH CENTERS
Entity Type:Organization
Organization Name:PACIFIC CENTRAL COAST HEALTH CENTERS
Other - Org Name:HANCOCK HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-739-3108
Mailing Address - Street 1:117 W BUNNY AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-2805
Mailing Address - Country:US
Mailing Address - Phone:805-739-3898
Mailing Address - Fax:805-614-5932
Practice Address - Street 1:116 S PALISADE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-8904
Practice Address - Country:US
Practice Address - Phone:805-739-3968
Practice Address - Fax:805-922-6101
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PACIFIC CENTRAL COAST HEALTH CENTERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-16
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherIRS
CAW14719Medicare PIN