Provider Demographics
NPI:1679933089
Name:COASTLANDS MINISTRIES/PROJECT LAZARUS
Entity Type:Organization
Organization Name:COASTLANDS MINISTRIES/PROJECT LAZARUS
Other - Org Name:PROJECT LAZARUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:WELLS
Authorized Official - Last Name:BRASON
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:336-667-8100
Mailing Address - Street 1:5368 NC HIGHWAY 16 S
Mailing Address - Street 2:
Mailing Address - City:MORAVIAN FALLS
Mailing Address - State:NC
Mailing Address - Zip Code:28654-9586
Mailing Address - Country:US
Mailing Address - Phone:336-667-8100
Mailing Address - Fax:866-400-9915
Practice Address - Street 1:5368 NC HIGHWAY 16 S
Practice Address - Street 2:
Practice Address - City:MORAVIAN FALLS
Practice Address - State:NC
Practice Address - Zip Code:28654-9586
Practice Address - Country:US
Practice Address - Phone:336-667-8100
Practice Address - Fax:866-400-9915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-26
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health