Provider Demographics
NPI:1235413089
Name:COAST THERAPEUTIC SERVICES, INC
Entity Type:Organization
Organization Name:COAST THERAPEUTIC SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:B
Authorized Official - Last Name:SCHWARZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-367-9655
Mailing Address - Street 1:145 108TH AVE
Mailing Address - Street 2:
Mailing Address - City:TREASURE ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33706-4747
Mailing Address - Country:US
Mailing Address - Phone:727-367-9655
Mailing Address - Fax:727-367-9661
Practice Address - Street 1:145 108TH AVE
Practice Address - Street 2:
Practice Address - City:TREASURE ISLAND
Practice Address - State:FL
Practice Address - Zip Code:33706-4747
Practice Address - Country:US
Practice Address - Phone:727-367-9655
Practice Address - Fax:727-367-9661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL06-52-AD-4303-01261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder