Provider Demographics
NPI:1639109085
Name:COASTAL LIVING, INC.
Entity Type:Organization
Organization Name:COASTAL LIVING, INC.
Other - Org Name:HARBOR HOUSE
Other - Org Type:Other Name
Authorized Official - Title/Position:LSW,QMRP
Authorized Official - Prefix:
Authorized Official - First Name:ELSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-242-8844
Mailing Address - Street 1:PO BOX 10606
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78460-0606
Mailing Address - Country:US
Mailing Address - Phone:361-242-8844
Mailing Address - Fax:361-241-5805
Practice Address - Street 1:10905 TIMBERGROVE
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78410
Practice Address - Country:US
Practice Address - Phone:361-242-3230
Practice Address - Fax:361-241-5805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115966315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities