Healthcare Provider Details

I. General information

NPI: 1891589438
Provider Name (Legal Business Name): CENTRAL COAST OVERDOSE PREVENTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2025
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 DEER STALKER PATH
MONTEREY CA
93940-6312
US

IV. Provider business mailing address

PO BOX 2101
MONTEREY CA
93942-2101
US

V. Phone/Fax

Practice location:
  • Phone: 877-226-3717
  • Fax:
Mailing address:
  • Phone: 831-682-5008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KHANH ALEXANDER NGOC NGUYEN WHITED
Title or Position: SYSTEM ADMINISTRATOR
Credential:
Phone: 650-469-2218