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General NPI Number Information
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NPI Number | 1134526783
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Entity Type | Organization
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Legal Business Name | COASTSIDE CONVALESCENT ASSOCIATES LLC
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Dates
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Enumeration Date | 11/25/2014
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Last Update Date | 11/25/2014
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Provider Practice Location Address
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Address Line | 1186 ACACIA STREET
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City | MONTARA
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State | CA
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Zip | 94037-1252
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Country | US
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Telephone | 650-728-5483
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Fax | 650-728-8649
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Provider Business Mailing Address
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Address Line | 1186 ACACIA STREET
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City | MONTARA
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State | CA
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Zip | 94037-1252
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Country | US
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Telephone | 650-728-5483
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Fax | 650-728-8649
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. SHAROLYN KRIGER
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Credential |
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Telephone | 650-728-5483
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 415600502
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License Number State | CA
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