Provider Demographics
NPI:1336163898
Name:COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST INC
Entity Type:Organization
Organization Name:COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST INC
Other - Org Name:COMMUNITY HEALTH CENTERS THE DOCTORS OFFICE
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-361-8014
Mailing Address - Street 1:2050 S BLOSSER
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458
Mailing Address - Country:US
Mailing Address - Phone:805-361-8014
Mailing Address - Fax:805-361-8097
Practice Address - Street 1:1057 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-2504
Practice Address - Country:US
Practice Address - Phone:805-481-7220
Practice Address - Fax:805-481-7097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHAP70693FOtherFAMILY PLANNING
CAFHC70693FMedicaid
CABCP70693FOtherCANCER DETECTION PROGRAM
CAZZZ52317ZOtherBLUE SHIELD OF CALIFORNIA
CABCP70693FOtherCANCER DETECTION PROGRAM
CAHAP70693FOtherFAMILY PLANNING