Provider Demographics
NPI:1588005698
Name:COASTAL HEALTHCARE
Entity Type:Organization
Organization Name:COASTAL HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF THERAPY
Authorized Official - Prefix:
Authorized Official - First Name:QUIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-525-1542
Mailing Address - Street 1:3801 CONNECTICUT AVE NW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-4530
Mailing Address - Country:US
Mailing Address - Phone:202-525-1542
Mailing Address - Fax:
Practice Address - Street 1:3801 CONNECTICUT AVE NW
Practice Address - Street 2:SUITE 100
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-4530
Practice Address - Country:US
Practice Address - Phone:202-525-1542
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCSLP000685252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency