Provider Demographics
NPI:1902611478
Name:COAST TO COAST DIGNITY FOR VETS, INC.
Entity type:Organization
Organization Name:COAST TO COAST DIGNITY FOR VETS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:KANUTE
Authorized Official - Suffix:
Authorized Official - Credentials:BS, CAS
Authorized Official - Phone:949-315-9225
Mailing Address - Street 1:PO BOX 9296
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92652-7261
Mailing Address - Country:US
Mailing Address - Phone:949-313-5275
Mailing Address - Fax:727-363-6994
Practice Address - Street 1:189 SAN MARCO AVE
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-2733
Practice Address - Country:US
Practice Address - Phone:949-313-5210
Practice Address - Fax:727-363-6994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-11
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility