Healthcare Provider Details

I. General information

NPI: 1457743957
Provider Name (Legal Business Name): E-ESHORA CCC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2015
Last Update Date: 03/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E OCEAN AVE SUITE 20
LOMPOC CA
93436-6937
US

IV. Provider business mailing address

1324 MARIGOLD WAY
LOMPOC CA
93436-8204
US

V. Phone/Fax

Practice location:
  • Phone: 805-743-1515
  • Fax: 805-819-0942
Mailing address:
  • Phone: 805-743-1515
  • Fax: 805-819-0942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberCCS #15096
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. LINDA J. NEUTZ
Title or Position: CHIEF EXECUTIVE OFFICER (CEO)
Credential: MA CATC IV/CCS 15096
Phone: 805-743-1515