Provider Demographics
NPI:1477161073
Name:COASTAL INTEGRATIVE HEALTHCARE INC
Entity Type:Organization
Organization Name:COASTAL INTEGRATIVE HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:STEFLIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-427-8403
Mailing Address - Street 1:145 CYPRESS POINT PKWY STE 208
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-8427
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:145 CYPRESS POINT PKWY STE 208
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-8427
Practice Address - Country:US
Practice Address - Phone:386-445-4455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COASTAL INTEGRATIVE HEALTHCARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies