Provider Demographics
NPI:1760993430
Name:LIBRE BEHAVIORAL HEALTHCARE LLC
Entity Type:Organization
Organization Name:LIBRE BEHAVIORAL HEALTHCARE LLC
Other - Org Name:COASTAL BEHAVIORAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:NAGRANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-522-9919
Mailing Address - Street 1:612 PALMETTO ST
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-7327
Mailing Address - Country:US
Mailing Address - Phone:386-492-6894
Mailing Address - Fax:
Practice Address - Street 1:3930 S NOVA RD STE 106
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-9293
Practice Address - Country:US
Practice Address - Phone:386-492-6894
Practice Address - Fax:407-522-9343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-20
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility