Provider Demographics
NPI:1114728623
Name:GOLDEN COAST HOMECARE
Entity type:Organization
Organization Name:GOLDEN COAST HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:FETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-210-9160
Mailing Address - Street 1:427 18TH AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-3165
Mailing Address - Country:US
Mailing Address - Phone:319-210-9160
Mailing Address - Fax:
Practice Address - Street 1:1101 CALIFORNIA AVE STE 203
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-6473
Practice Address - Country:US
Practice Address - Phone:319-210-9160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care