- Enrollment id
- O20150717001322
- Enrollment state
- CA
- Provider type code
- 00-04
- Provider type text
- PART A PROVIDER - FEDERALLY QUALIFIED HEALTH CENTER (FQHC)
- Npi
- 1033596911
- Multiple npi flag
- N
- Ccn
- 751161
- Associate id
- 2466345632
- Organization name
- COUNTY OF MONTEREY
- Doing business as name
- LAUREL VISTA
- Incorporation date
- 2015-05-12
- Incorporation state
- CA
- Organization type structure
- GOVERNMENT
- Proprietary nonprofit
- N
- Address line 1
- 1441 CONSTITUTION BLVD
- Address line 2
- BLDG 400, STE 301
- City
- SALINAS
- State
- CA
- Zip code
- 939063134
- Telephone number
- 8317554000