Provider Demographics
NPI:1558732024
Name:COASTAL BEHAVIORAL HEALTH CARE
Entity Type:Organization
Organization Name:COASTAL BEHAVIORAL HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:MISS
Authorized Official - First Name:GEORGIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:OLEARY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:9413-312-8530
Mailing Address - Street 1:6039 BENEVENTO DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-2883
Mailing Address - Country:US
Mailing Address - Phone:941-552-6272
Mailing Address - Fax:
Practice Address - Street 1:6039 BENEVENTO DR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238-2883
Practice Address - Country:US
Practice Address - Phone:941-552-6272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-09
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9292201251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL163W00000XMedicaid
FL163W00000XOtherCOASTAL BEHAVIORAL HEALTH CARE OUT PATIENT