Provider Demographics
NPI:1093246639
Name:COASTAL ATLANTIC DAY HABILITATION & TREATMENT CENTER
Entity Type:Organization
Organization Name:COASTAL ATLANTIC DAY HABILITATION & TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:K
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-210-1758
Mailing Address - Street 1:177 CHERRY LAURAL LN
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-9495
Mailing Address - Country:US
Mailing Address - Phone:912-210-1758
Mailing Address - Fax:
Practice Address - Street 1:6412 WATERS AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2712
Practice Address - Country:US
Practice Address - Phone:912-210-1758
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services