Provider Demographics
NPI:1669777868
Name:SOUTH COAST PT INC
Entity type:Organization
Organization Name:SOUTH COAST PT INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SETAREH
Authorized Official - Middle Name:
Authorized Official - Last Name:SALEHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-855-3926
Mailing Address - Street 1:23221 S POINTE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1400
Mailing Address - Country:US
Mailing Address - Phone:949-855-3926
Mailing Address - Fax:949-855-3921
Practice Address - Street 1:23221 S POINTE DR STE 101
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1400
Practice Address - Country:US
Practice Address - Phone:949-855-3926
Practice Address - Fax:949-855-3921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-19
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT18387320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities