1255441358 NPI number — COASTAL HEALTH ALLIANCE

Table of content: (NPI 1255441358)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255441358 NPI number — COASTAL HEALTH ALLIANCE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COASTAL HEALTH ALLIANCE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255441358
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 910
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POINT REYES STATION
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94956-0910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-663-8781
Provider Business Mailing Address Fax Number:
415-663-9632

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3419 STATE ROUTE ONE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STINSON BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94970-0978
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-868-9656
Provider Business Practice Location Address Fax Number:
415-868-2858
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SEVERSON
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
415-663-8781

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , with the licence number:  110000413 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: FHC53833F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com