Healthcare Provider Details

I. General information

NPI: 1891138129
Provider Name (Legal Business Name): COAST TO COAST ADULT DAY HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2013
Last Update Date: 04/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6650 RESEDA BLVD SUITE 101-A
RESEDA CA
91335-5340
US

IV. Provider business mailing address

6650 RESEDA BLVD SUITE 101-A
RESEDA CA
91335-5340
US

V. Phone/Fax

Practice location:
  • Phone: 818-836-2475
  • Fax: 818-708-9668
Mailing address:
  • Phone: 818-836-2475
  • Fax: 818-708-9668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberE4159
License Number StateCA

VIII. Authorized Official

Name: DR. CHRISTOPHER OTIKO
Title or Position: CEO
Credential: DPM
Phone: 818-836-2475