Provider Demographics
NPI:1417663147
Name:COASTAL COMMUNITY HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:COASTAL COMMUNITY HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KAVANAUGH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANDLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-275-8028
Mailing Address - Street 1:100 PROFESSIONAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-6743
Mailing Address - Country:US
Mailing Address - Phone:912-275-8028
Mailing Address - Fax:
Practice Address - Street 1:1299 GA HIGHWAY 57
Practice Address - Street 2:
Practice Address - City:TOWNSEND
Practice Address - State:GA
Practice Address - Zip Code:31331-8128
Practice Address - Country:US
Practice Address - Phone:912-574-5277
Practice Address - Fax:912-549-1040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)