# CENTRAL COAST SKILLED CARE, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Lompoc Skilled & Rehab. Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760472872
- **Authorized official:** RONALD WOODALL (PRESIDENT/CEO)
- **Authorized official phone:** (209) 533-3333

## Contact information

- **Practice address:** 1428 W NORTH AVE, LOMPOC, CA 93436-3961
- **Practice address phone:** (805) 735-4010
- **Practice address fax:** (805) 736-4296
- **Mailing address:** 133 OLD WARDS FERRY RD, SUITE G, SONORA, CA 95370-7822
- **Mailing address phone:** (209) 533-3333
- **Mailing address fax:** (209) 533-3160

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | CA | Yes |

## Other

- **Enumeration date:** 10/28/2005
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 05A420 | — | CA |