1821504465 NPI number — COASTAL HORIZONS CENTER INC.

Table of content: (NPI 1821504465)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821504465 NPI number — COASTAL HORIZONS CENTER INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COASTAL HORIZONS CENTER 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:
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:
1821504465
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
615 SHIPYARD BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28412-6431
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-343-0145
Provider Business Mailing Address Fax Number:
910-341-5709

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
613 SHIPYARD BOULEVARD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28412-6492
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-769-1095
Provider Business Practice Location Address Fax Number:
910-769-3665
Provider Enumeration Date:
12/19/2017

Additional Information

Authorized Official

Authorized Official Last Name:
JOINES
Authorized Official First Name:
TALMADGE
Authorized Official Middle Name:
LINDSAY
Authorized Official Title or Position:
QUALITY IMPROVEMENT TRAINING DIR.
Authorized Official Telephone Number:
910-202-5709

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 800416Q , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8300416H , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8301322Q , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8302795Q , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8301322H , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3410030 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8300416 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8300416T , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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