Provider Demographics
NPI:1568705606
Name:COASTAL LIVING LLC
Entity Type:Organization
Organization Name:COASTAL LIVING LLC
Other - Org Name:BANANA RIVER VILLAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:E
Authorized Official - Last Name:FINES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:407-451-5894
Mailing Address - Street 1:1800 33RD ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839-8852
Mailing Address - Country:US
Mailing Address - Phone:407-451-5894
Mailing Address - Fax:407-386-6267
Practice Address - Street 1:1275 N BANANA RIVER DR
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-5788
Practice Address - Country:US
Practice Address - Phone:321-704-6190
Practice Address - Fax:407-386-6267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11441310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility