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Organization

REDWOOD COAST MEDICAL SERVICES, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DIANE AGEE (CEO)
(707) 884-9476
Entity
Organization

Contact information

Practice address
46900 OCEAN DR, GUALALA, CA 95445-8353
(707) 884-4005
(707) 884-9728
Mailing address
PO BOX 1100, GUALALA, CA 95445-1100
(707) 884-4005
(707) 884-9728

Taxonomy

Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
110000048
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
FHC03906F
CA
Enumeration date
03/01/2007
Last updated
12/24/2013
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