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COASTAL RESIDENTIAL SERVICES INC NPI 1780792705


NPI Information

NPI: 1780792705
Provider Name: COASTAL RESIDENTIAL SERVICES, INC
Classification: Community/Behavioral Health - 251S00000X
Entity Type: Organization

CLIA Number: 34D2115326

Address:
445 WESTERN BLVD STE T
JACKSONVILLE, NC
ZIP 28546
Phone: (910) 938-9550
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COASTAL RESIDENTIAL SERVICES, INC is a community behavioral health in Jacksonville, NC. The provider is a private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. COASTAL RESIDENTIAL SERVICES, INC NPI is 1780792705. The provider is registered as an organization entity type.

The provider's business location address is:

445 WESTERN BLVD STE T
JACKSONVILLE, NC
ZIP 28546-852
Phone: (910) 938-9550
Fax: (910) 346-9186

The provider's authorized official is Carol Wilson .
The authorized official title is Vice President and has the following contact phone number (910) 938-9550.

The CLIA number assigned to this NPI record is 34D2115326 - other - group home with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/29/2006 and was last updated on 11/18/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1320900000XCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesMHL-067-059NORTH CAROLINANo
2320900000XCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesMHL-067049NORTH CAROLINANo
3320900000XCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesMHL-067-052NORTH CAROLINANo
4320900000XCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesMHL-067-091NORTH CAROLINANo
5251S00000XCommunity/Behavioral HealthMHL-067-085NORTH CAROLINAYes
6251S00000XCommunity/Behavioral HealthMHL-067-091NORTH CAROLINANo
7251S00000XCommunity/Behavioral HealthMHL-067-059NORTH CAROLINANo
8251S00000XCommunity/Behavioral HealthMHL-067-049NORTH CAROLINANo
9251S00000XCommunity/Behavioral HealthMHL-067-052NORTH CAROLINANo

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
13408942MEDICAIDNORTH CAROLINA
23419231MEDICAIDNORTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.