1659862936 NPI number — COAST COMMUNITY HEALTH CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659862936 NPI number — COAST COMMUNITY HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COAST COMMUNITY HEALTH CENTER
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:
1659862936
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/23/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1010 1ST ST SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BANDON
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97411-9301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-347-2529
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
716 HIGHWAY 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT ORFORD
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97465-8672
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-951-7723
Provider Business Practice Location Address Fax Number:
541-347-9196
Provider Enumeration Date:
05/23/2018

Additional Information

Authorized Official

Authorized Official Last Name:
MAXON
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
541-347-2529

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: RP-0003382-CS , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2177719 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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