MEDICARE: COAST TO COAST REFERRAL CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital

General Provider Information

NPI Number	:	1720368020
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COAST TO COAST REFERRAL CENTER, INC.

Provider Business Mailing Address
First Line	:	1316 S COAST HWY
Second Line	:
City	:	LAGUNA BEACH
State	:	CA
Zip	:	92651-3118
Country	:	US
Telephone Number	:	949-313-5250
Fax Number	:	949-313-5250

Provider Business Practice Location Address
First Line	:	1404 N PALM CANYON DR
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-4408
Country	:	US
Telephone Number	:	760-778-4876
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM ADMINISTRATOR
Name	:	MR. MICHAEL JOHN COHAN JR.
Credential	:	BS
Telephone Number	:	949-313-5250

Provider Enumeration Date	:	08/18/2011
Last Update Date	:	08/18/2011

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