Provider Demographics
NPI:1669674883
Name:COASTAL AREA SUPPORT ALTERNATIVES, INC.
Entity Type:Organization
Organization Name:COASTAL AREA SUPPORT ALTERNATIVES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-851-0688
Mailing Address - Street 1:5809 PATTON ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-2428
Mailing Address - Country:US
Mailing Address - Phone:361-851-0688
Mailing Address - Fax:361-851-0011
Practice Address - Street 1:5809 PATTON ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-2428
Practice Address - Country:US
Practice Address - Phone:361-851-0688
Practice Address - Fax:361-851-0011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health