Provider Demographics
NPI:1922198787
Name:SAN LUIS OBISPO COUNTY CCS
Entity Type:Organization
Organization Name:SAN LUIS OBISPO COUNTY CCS
Other - Org Name:SAN LUIS OBISPO MEDICAL THERAPY UNIT
Other - Org Type:Other Name
Authorized Official - Title/Position:SUPERVISING THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:FREILER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-781-4266
Mailing Address - Street 1:251 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-2009
Mailing Address - Country:US
Mailing Address - Phone:805-781-4266
Mailing Address - Fax:805-788-2180
Practice Address - Street 1:251 GRAND AVE
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-2009
Practice Address - Country:US
Practice Address - Phone:805-781-4266
Practice Address - Fax:805-788-2180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation