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Organization

COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST INC

Active
Other names
Community Health Centers Coast Medical Center
Organization subpart
No

Provider details

NPI number
Authorized official
RONALD E CASTLE (CHIEF EXECUTIVE OFFICER)
(805) 929-3211
Entity
Organization

Contact information

Practice address
336 S HALCYON RD, ARROYO GRANDE, CA 93420-3898
(805) 489-3652
(805) 481-1017
Mailing address
150 TEJAS PL, PO BOX 430, NIPOMO, CA 93444-9123
(805) 929-3211
(805) 929-6440

Taxonomy

Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
BCP70593F
CANCER DETECTION PROGRAM
CA
05
FHC70593F
CA
01
HAP70593F
FAMILY PLANNING
CA
01
ZZZ52117Z
BLUE SHIELD
CA
Enumeration date
07/16/2006
Last updated
10/30/2012
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