Provider Demographics
NPI:1598726648
Name:COASTAL BEHAVIORAL HEALTHCARE, INC.
Entity Type:Organization
Organization Name:COASTAL BEHAVIORAL HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING/CLAIMS/MANAGEDCARE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:HABERMEHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-331-2530
Mailing Address - Street 1:4579 NORTHGATE CT
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34234-2124
Mailing Address - Country:US
Mailing Address - Phone:941-366-5333
Mailing Address - Fax:941-927-6315
Practice Address - Street 1:4579 NORTHGATE CT
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34234-2124
Practice Address - Country:US
Practice Address - Phone:941-927-8900
Practice Address - Fax:941-308-2931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251S00000X, 323P00000X
FL1423251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL060975721Medicaid
FL060975728Medicaid
FL060975700Medicaid
FL060975725Medicaid
FL060975716Medicaid
FL060975717Medicaid
FL060975726Medicaid
FL060975720Medicaid
FL060975715Medicaid
FL060975722Medicaid
FL060975741Medicaid
FL060975721Medicaid