Healthcare Provider Details

I. General information

NPI: 1881611705
Provider Name (Legal Business Name): COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 01/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2515 MAIN ST SUITE B
CAMBRIA CA
93428-3407
US

IV. Provider business mailing address

2050 S BLOSSER RD
SANTA MARIA CA
93458-7310
US

V. Phone/Fax

Practice location:
  • Phone: 805-927-5292
  • Fax: 805-927-0354
Mailing address:
  • Phone: 805-361-8014
  • Fax: 805-361-8097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: BARBARA ALLEN
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 805-361-8014