Provider Demographics
NPI:1720209562
Name:COASTAL BEHAVIORAL HEALTHCARE
Entity Type:Organization
Organization Name:COASTAL BEHAVIORAL HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAPHNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BETTS-HEMBY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:252-946-8240
Mailing Address - Street 1:1005 BROWN ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-4670
Mailing Address - Country:US
Mailing Address - Phone:252-946-8240
Mailing Address - Fax:252-946-8249
Practice Address - Street 1:1005 BROWN ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-4670
Practice Address - Country:US
Practice Address - Phone:252-946-8240
Practice Address - Fax:252-946-8249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300906BMedicaid