Provider Demographics
NPI:1144737016
Name:SEA COAST RECOVERY, LLC
Entity Type:Organization
Organization Name:SEA COAST RECOVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DOMINICKA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-540-6512
Mailing Address - Street 1:7302 PLUMLEAF RD APT 1617
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-3899
Mailing Address - Country:US
Mailing Address - Phone:201-540-6512
Mailing Address - Fax:
Practice Address - Street 1:880 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2600
Practice Address - Country:US
Practice Address - Phone:984-364-8693
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-02
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility