1750305231 NPI number — COASTAL BEHAVIORAL HEALTH

Table of content: TANISHA DARNETTE JONES LPN (NPI 1700616976)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750305231 NPI number — COASTAL BEHAVIORAL HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COASTAL BEHAVIORAL HEALTH
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:
Provider Other Organization Name Type Code:
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:
1750305231
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
567 VAUXHALL STREET EXT
Provider Second Line Business Mailing Address:
SUITE 118
Provider Business Mailing Address City Name:
WATERFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06385-4330
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-444-0503
Provider Business Mailing Address Fax Number:
860-444-0504

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
567 VAUXHALL STREET EXT
Provider Second Line Business Practice Location Address:
SUITE 118
Provider Business Practice Location Address City Name:
WATERFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06385-4330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-444-0503
Provider Business Practice Location Address Fax Number:
860-444-0504
Provider Enumeration Date:
07/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MALONEY
Authorized Official First Name:
MARTIN
Authorized Official Middle Name:
JUDE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
860-444-0503

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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