Provider Demographics
NPI:1891138129
Name:COAST TO COAST ADULT DAY HEALTH CARE
Entity Type:Organization
Organization Name:COAST TO COAST ADULT DAY HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:OTIKO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:818-836-2475
Mailing Address - Street 1:6650 RESEDA BLVD
Mailing Address - Street 2:SUITE 101-A
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-5340
Mailing Address - Country:US
Mailing Address - Phone:818-836-2475
Mailing Address - Fax:818-708-9668
Practice Address - Street 1:6650 RESEDA BLVD
Practice Address - Street 2:SUITE 101-A
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-5340
Practice Address - Country:US
Practice Address - Phone:818-836-2475
Practice Address - Fax:818-708-9668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4159261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE4159OtherPODIATRY LICENSE