Provider Demographics
NPI:1497463491
Name:COASTAL BREEZE MENTAL HEALTH A NURSING CORPORATION
Entity Type:Organization
Organization Name:COASTAL BREEZE MENTAL HEALTH A NURSING CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUDWICK
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:831-291-3540
Mailing Address - Street 1:2460 17TH AVE STE 1030
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-1860
Mailing Address - Country:US
Mailing Address - Phone:831-291-3540
Mailing Address - Fax:
Practice Address - Street 1:134 ROBINSON LANE
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-1860
Practice Address - Country:US
Practice Address - Phone:831-291-3540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-08
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty