Provider Demographics
NPI:1578588406
Name:COASTAL HEALTH & WELLNESS
Entity Type:Organization
Organization Name:COASTAL HEALTH & WELLNESS
Other - Org Name:GALVESTON COUNTY COORDINATED COMMUNITY CLINICS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SALCIDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-938-2240
Mailing Address - Street 1:PO BOX 939
Mailing Address - Street 2:
Mailing Address - City:LA MARQUE
Mailing Address - State:TX
Mailing Address - Zip Code:77568-0939
Mailing Address - Country:US
Mailing Address - Phone:409-938-2240
Mailing Address - Fax:409-938-2200
Practice Address - Street 1:9850C EMMETT F LOWRY EXPY STE C103
Practice Address - Street 2:
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591-2122
Practice Address - Country:US
Practice Address - Phone:409-938-2234
Practice Address - Fax:099-382-2004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0190530-01Medicaid