Provider Demographics
NPI:1457743957
Name:E-ESHORA CCC, INC.
Entity type:Organization
Organization Name:E-ESHORA CCC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER (CEO)
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:NEUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MA CATC IV/CCS 15096
Authorized Official - Phone:805-743-1515
Mailing Address - Street 1:1324 MARIGOLD WAY
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-8204
Mailing Address - Country:US
Mailing Address - Phone:805-743-1515
Mailing Address - Fax:805-819-0942
Practice Address - Street 1:601 E OCEAN AVE
Practice Address - Street 2:SUITE 20
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-6937
Practice Address - Country:US
Practice Address - Phone:805-743-1515
Practice Address - Fax:805-819-0942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-20
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251V00000X
CACCS #15096251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1760686489OtherCOUNTY OF SANTA BARBARA ALCOHOL/DRUG & MENTAL HEALTH SERVICES MEDI-CAL PROVIDER