Provider Demographics
NPI:1356643316
Name:COASTAL COMMUNITY ACTION PROGRAM
Entity Type:Organization
Organization Name:COASTAL COMMUNITY ACTION PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:L
Authorized Official - Last Name:DUBLANKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-533-5100
Mailing Address - Street 1:117 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-4002
Mailing Address - Country:US
Mailing Address - Phone:360-533-5100
Mailing Address - Fax:360-532-4623
Practice Address - Street 1:117 E 3RD ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-4002
Practice Address - Country:US
Practice Address - Phone:360-533-5100
Practice Address - Fax:360-532-4623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-24
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7408222Medicaid