Provider Demographics
NPI:1164873915
Name:COASTAL RE-ENTRY AND VETERAN'S COALITION, INC
Entity Type:Organization
Organization Name:COASTAL RE-ENTRY AND VETERAN'S COALITION, INC
Other - Org Name:CAMDEN COUNTY RE-ENTRY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:CUMMINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-729-1501
Mailing Address - Street 1:PO BOX 1043
Mailing Address - Street 2:
Mailing Address - City:WOODBINE
Mailing Address - State:GA
Mailing Address - Zip Code:31569-1043
Mailing Address - Country:US
Mailing Address - Phone:912-729-1501
Mailing Address - Fax:912-729-4837
Practice Address - Street 1:208 E 4TH ST
Practice Address - Street 2:
Practice Address - City:WOODBINE
Practice Address - State:GA
Practice Address - Zip Code:31569-3748
Practice Address - Country:US
Practice Address - Phone:912-729-1501
Practice Address - Fax:912-729-4837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management