Provider Demographics
NPI:1902349665
Name:CENTRAL COAST HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:CENTRAL COAST HEALTH SERVICES, LLC
Other - Org Name:MIRACLE-EAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:JUNE
Authorized Official - Last Name:HYLTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-208-7801
Mailing Address - Street 1:1059 E IRON EAGLE DR
Mailing Address - Street 2:SUITE 175
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-6855
Mailing Address - Country:US
Mailing Address - Phone:360-208-7801
Mailing Address - Fax:208-475-4507
Practice Address - Street 1:531 N H ST
Practice Address - Street 2:SUITE B
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-5323
Practice Address - Country:US
Practice Address - Phone:805-724-3273
Practice Address - Fax:208-475-4507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABR616024237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty