Provider Demographics
NPI:1245562347
Name:COASTAL REHABILITATION AND TREATMENT SERVICES.
Entity type:Organization
Organization Name:COASTAL REHABILITATION AND TREATMENT SERVICES.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:BISHOP
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-566-0037
Mailing Address - Street 1:114 APALACHEE STREET
Mailing Address - Street 2:
Mailing Address - City:CARRABELLE
Mailing Address - State:FL
Mailing Address - Zip Code:32322-3524
Mailing Address - Country:US
Mailing Address - Phone:850-566-0037
Mailing Address - Fax:850-697-3891
Practice Address - Street 1:3295 CRAWFORDVILLE HWY
Practice Address - Street 2:
Practice Address - City:CRAWFORDVILLE
Practice Address - State:FL
Practice Address - Zip Code:32327-3150
Practice Address - Country:US
Practice Address - Phone:850-566-0037
Practice Address - Fax:850-697-3891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-01
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0219AD101900261QC1500X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002056000Medicaid