Healthcare Provider Details

I. General information

NPI: 1568503282
Provider Name (Legal Business Name): COASTSIDE ADULT DAY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 CORREAS ST
HALF MOON BAY CA
94019-1962
US

IV. Provider business mailing address

645 CORREAS ST
HALF MOON BAY CA
94019-1962
US

V. Phone/Fax

Practice location:
  • Phone: 650-726-5067
  • Fax: 650-726-8743
Mailing address:
  • Phone: 650-726-5067
  • Fax: 650-726-8743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: MS. JANIE BONO
Title or Position: EXECUTIVE DIRECTOR
Credential: R.N.
Phone: 650-726-5067