Organization
COAST VALLEY WORSHIP CENTER
Active
Other names
Coast Valley Substance Abuse Treatment Center
Organization subpart
No
Provider details
NPI number
Authorized official
EDWIN MATTHEW HAMLIN (DIRECTOR)
(805) 739-1512
Entity
Organization
Contact information
Practice address
1125 E CLARK AVE, STE A2, SANTA MARIA, CA 93455-5111
(805) 739-1512
(805) 739-2855
Mailing address
1125 E CLARK AVE, STE A2, SANTA MARIA, CA 93455-5111
(805) 739-1512
(805) 739-2855
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
420030AN
CA
251B00000X
Case Management Agency
420030BN
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
60150
MEDI-CAL PROVIDER NUMBER
CA
01
—
60180
MEDI-CAL PROVIDER NUMBER
CA
Enumeration date
03/23/2007
Last updated
06/14/2011
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