Basic Information
| Provider Information | |||||||||
| NPI: | 1649765850 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COASTAL HORIZONS CENTER INC | ||||||||
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| OtherOrganizationName: | COASTAL HORIZONS CENTER, INC. | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 615 SHIPYARD BLVD | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284126431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102025709 | ||||||||
| FaxNumber: | 9102029966 | ||||||||
| Practice Location | |||||||||
| Address1: | 301 MERCER MILL RD | ||||||||
| Address2: | |||||||||
| City: | ELIZABETHTOWN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283373960 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9108623380 | ||||||||
| FaxNumber: | 8448295496 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2018 | ||||||||
| LastUpdateDate: | 06/29/2018 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | JOINES | ||||||||
| AuthorizedOfficialFirstName: | TALMADGE | ||||||||
| AuthorizedOfficialMiddleName: | LINDSAY | ||||||||
| AuthorizedOfficialTitleorPosition: | QUALITY IMPROVEMENT TRAINING DIRECT | ||||||||
| AuthorizedOfficialTelephone: | 9102025709 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | COASTAL HORIZONS CENTER INC | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.