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General NPI Number Information
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NPI Number | 1265803266
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Entity Type | Organization
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Legal Business Name | CENTRAL COAST FREEDOM HOUSE
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Dates
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Enumeration Date | 10/16/2015
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Last Update Date | 10/16/2015
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Provider Practice Location Address
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Address Line | 5755 DOLORES AVE
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City | ATASCADERO
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State | CA
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Zip | 93422-3524
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Country | US
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Telephone | 562-344-6080
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Fax |
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Provider Business Mailing Address
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Address Line | 6621 E PACIFIC COAST HWY STE 115
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City | LONG BEACH
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State | CA
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Zip | 90803-4244
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | COO
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Name | KRISTEN MCKNIGHT
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Credential |
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Telephone | 626-765-3946
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State | CA
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