Provider Demographics
NPI:1659928174
Name:COASTAL POINTE SENIOR LIVING LLC
Entity Type:Organization
Organization Name:COASTAL POINTE SENIOR LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:HUGH
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-332-4508
Mailing Address - Street 1:201 N FRONT ST STE 805
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-5089
Mailing Address - Country:US
Mailing Address - Phone:910-332-4508
Mailing Address - Fax:910-332-4512
Practice Address - Street 1:5220 OCEAN HWY W
Practice Address - Street 2:
Practice Address - City:SHALLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28470-4006
Practice Address - Country:US
Practice Address - Phone:910-332-4508
Practice Address - Fax:910-332-4512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility