1639109085 NPI number — COASTAL LIVING, INC.

Table of content: (NPI 1639109085)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639109085 NPI number — COASTAL LIVING, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COASTAL LIVING, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HARBOR HOUSE
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639109085
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10606
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORPUS CHRISTI
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78460-0606
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-242-8844
Provider Business Mailing Address Fax Number:
361-241-5805

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10905 TIMBERGROVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORPUS CHRISTI
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-242-3230
Provider Business Practice Location Address Fax Number:
361-241-5805
Provider Enumeration Date:
07/03/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ADAMS
Authorized Official First Name:
ELSA
Authorized Official Middle Name:
Authorized Official Title or Position:
LSW,QMRP
Authorized Official Telephone Number:
361-242-8844

Provider Taxonomy Codes

  • Taxonomy code: 315P00000X , with the licence number:  115966 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)