Provider Demographics
NPI:1568657534
Name:COASTAL COMMUNITY ACTION, INC
Entity Type:Organization
Organization Name:COASTAL COMMUNITY ACTION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEVUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:J
Authorized Official - Last Name:TRAVERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-223-1630
Mailing Address - Street 1:PO BOX 729
Mailing Address - Street 2:303 MCQUEEN AVE.
Mailing Address - City:NEWPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28570-0729
Mailing Address - Country:US
Mailing Address - Phone:252-223-1630
Mailing Address - Fax:252-223-1689
Practice Address - Street 1:303 MCQUEEN BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:NC
Practice Address - Zip Code:28570-8121
Practice Address - Country:US
Practice Address - Phone:252-223-1630
Practice Address - Fax:252-223-1689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2007-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300007Medicaid
NC8300007KMedicaid