Provider Demographics
NPI:1376042804
Name:COASTAL CARE ALLIANCE
Entity Type:Organization
Organization Name:COASTAL CARE ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:TELL
Authorized Official - Middle Name:D
Authorized Official - Last Name:SACKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-432-6068
Mailing Address - Street 1:36 WADLEIGH ST APT A
Mailing Address - Street 2:
Mailing Address - City:PARSONSFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04047-6269
Mailing Address - Country:US
Mailing Address - Phone:207-432-6068
Mailing Address - Fax:
Practice Address - Street 1:36 WADLEIGH ST APT A
Practice Address - Street 2:
Practice Address - City:PARSONSFIELD
Practice Address - State:ME
Practice Address - Zip Code:04047-6269
Practice Address - Country:US
Practice Address - Phone:207-432-6068
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-10
Last Update Date:2018-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No253Z00000XAgenciesIn Home Supportive Care
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No251300000XAgenciesLocal Education Agency (LEA)