Organization
COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST INC
Active
Other names
COMM HEALTH CENTERS SANTA MARIA II
Organization subpart
No
Provider details
NPI number
Authorized official
BARBARA A ALLEN (DIRECTOR OF BUSINESS OFFICE)
(805) 361-8014
Entity
Organization
Contact information
Practice address
1835 N BROADWAY, SANTA MARIA, CA 93454-1404
(805) 346-2753
(805) 922-2479
Mailing address
150 TEJAS PL, NIPOMO, CA 93444-9123
(805) 929-3211
(805) 929-6440
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
550000402
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CMM71166F
—
CA
01
—
W150B
PTAN GROUP #
CA
01
—
ZZZ69714Z
BLUE SHIELD
CA
Enumeration date
03/22/2007
Last updated
12/12/2023
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