Provider Demographics
NPI:1710527999
Name:COSTAL SUPPORT SERVICES
Entity Type:Organization
Organization Name:COSTAL SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:CHERRYHOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-264-0457
Mailing Address - Street 1:1808 NE HIGHWAY 101
Mailing Address - Street 2:
Mailing Address - City:LINCOLN CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97367
Mailing Address - Country:US
Mailing Address - Phone:541-418-5118
Mailing Address - Fax:877-388-8131
Practice Address - Street 1:1808 NE HIGHWAY 101
Practice Address - Street 2:
Practice Address - City:LINCOLN CITY
Practice Address - State:OR
Practice Address - Zip Code:97367
Practice Address - Country:US
Practice Address - Phone:541-270-8767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-15
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management