Provider Demographics
NPI:1164963542
Name:COASTAL RECOVERY SOLUTIONS, INC.
Entity Type:Organization
Organization Name:COASTAL RECOVERY SOLUTIONS, INC.
Other - Org Name:CHANGING TIDES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AUBREY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BRIGGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-423-1048
Mailing Address - Street 1:3512 VIRGINIA DARE TRL N
Mailing Address - Street 2:
Mailing Address - City:KITTY HAWK
Mailing Address - State:NC
Mailing Address - Zip Code:27949-4079
Mailing Address - Country:US
Mailing Address - Phone:252-423-1048
Mailing Address - Fax:
Practice Address - Street 1:3512 VIRGINIA DARE TRL N
Practice Address - Street 2:
Practice Address - City:KITTY HAWK
Practice Address - State:NC
Practice Address - Zip Code:27949-4079
Practice Address - Country:US
Practice Address - Phone:252-423-1048
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-17
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility