| South Coast Community Services | |
|
1030 Nevada St Ste 200 Redlands CA 92374-2958 | |
| (909) 792-0474 | |
| Not Available |
| Full Name | South Coast Community Services |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1030 Nevada St Ste 200, Redlands, California |
| Authorized Official Name and Position | Kathleen Darling (COO) |
| Authorized Official Contact | 9098384274 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| South Coast Community Services 25910 Acero Ste 160 Mission Viejo CA 92691-2777 Ph: (909) 980-7000 | South Coast Community Services 1030 Nevada St Ste 200 Redlands CA 92374-2958 Ph: (909) 792-0474 |
| NPI Number | 1013148196 |
|---|---|
| Provider Enumeration Date | 08/06/2009 |
| Last Update Date | 04/20/2023 |
| Certification Date | 04/20/2023 |
| Medicare PECOS PAC ID | 7315078789 |
|---|---|
| Medicare Enrollment ID | O20100629000241 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013148196 | NPI | - | NPPES |
| 36ER | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Andrew J Elliott |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1053423384 PECOS PAC ID: 4082526587 Enrollment ID: I20031103000698 |
| Provider Name | James S Maurer |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1659323392 PECOS PAC ID: 1355335548 Enrollment ID: I20040412000618 |
| Provider Name | My T Kha |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1154455384 PECOS PAC ID: 3173660123 Enrollment ID: I20091022000636 |
| Provider Name | Uzma Anwer Rehman Khan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1053517490 PECOS PAC ID: 7113103482 Enrollment ID: I20110520000640 |
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