Healthcare Provider Details

I. General information

NPI: 1609044924
Provider Name (Legal Business Name): CENTRAL COAST HOME HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2008
Last Update Date: 09/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

253 GRANADA DR SUITE D
SAN LUIS OBISPO CA
93401-7340
US

IV. Provider business mailing address

253 GRANADA DR SUITE D
SAN LUIS OBISPO CA
93401-7340
US

V. Phone/Fax

Practice location:
  • Phone: 805-543-2244
  • Fax: 805-543-2224
Mailing address:
  • Phone: 805-543-2244
  • Fax: 805-543-2224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number550000764
License Number StateCA

VIII. Authorized Official

Name: BRIAN PRITT
Title or Position: PRESIDENT
Credential:
Phone: 805-543-2244