- Enrollment id
- O20080423000757
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1609044924
- Multiple npi flag
- N
- Ccn
- 059010
- Associate id
- 9638257108
- Organization name
- CENTRAL COAST HOME HEALTH INC
- Incorporation date
- 2008-01-25
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 253 GRANADA DR D
- City
- SAN LUIS OBISPO
- State
- CA
- Zip code
- 934017340
- Practice location type
- HHA BRANCH