| Coastal Residential Services | |
|
445 Western Blvd Ste T Jacksonville NC 28546-6852 | |
| (910) 938-9550 | |
| (910) 346-9186 |
| Full Name | Coastal Residential Services |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 445 Western Blvd Ste T, Jacksonville, North Carolina |
| Authorized Official Name and Position | Carol Wilson (VICE PRESIDENT) |
| Authorized Official Contact | 9109389550 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Coastal Residential Services Po Box 7128 Jacksonville NC 28540-2128 Ph: (910) 938-9550 | Coastal Residential Services 445 Western Blvd Ste T Jacksonville NC 28546-6852 Ph: (910) 938-9550 |
| NPI Number | 1154516169 |
|---|---|
| Provider Enumeration Date | 09/12/2007 |
| Last Update Date | 11/18/2020 |
| Certification Date | 11/18/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154516169 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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