Provider Demographics
NPI:1255426086
Name:EAST COAST FAMILY SERVICES, INC.
Entity type:Organization
Organization Name:EAST COAST FAMILY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/C.E.O.
Authorized Official - Prefix:MS
Authorized Official - First Name:EWENDOLYN
Authorized Official - Middle Name:F
Authorized Official - Last Name:KIRT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-384-1935
Mailing Address - Street 1:1109 8TH ST
Mailing Address - Street 2:STE. 5
Mailing Address - City:MORGAN CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70380-1900
Mailing Address - Country:US
Mailing Address - Phone:985-384-1935
Mailing Address - Fax:985-384-8196
Practice Address - Street 1:1109 8TH ST
Practice Address - Street 2:STE. 5
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-1900
Practice Address - Country:US
Practice Address - Phone:985-384-1935
Practice Address - Fax:985-384-8196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA252101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5F778Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER