Provider Demographics
NPI:1467984617
Name:COASTLINE RECOVERY FOR WOMEN LLC
Entity Type:Organization
Organization Name:COASTLINE RECOVERY FOR WOMEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-345-5577
Mailing Address - Street 1:18377 BEACH BLVD
Mailing Address - Street 2:SUITE 330
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-1381
Mailing Address - Country:US
Mailing Address - Phone:949-345-5577
Mailing Address - Fax:
Practice Address - Street 1:18377 BEACH BLVD
Practice Address - Street 2:SUITE 330
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-1381
Practice Address - Country:US
Practice Address - Phone:949-345-5577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility