Provider Demographics
NPI:1356779409
Name:C4C COASTAL BEND INC,
Entity type:Organization
Organization Name:C4C COASTAL BEND INC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-870-9590
Mailing Address - Street 1:7405 GREENBACK LN # 140
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95621
Mailing Address - Country:US
Mailing Address - Phone:916-870-9590
Mailing Address - Fax:
Practice Address - Street 1:302 AVENUE D
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-8529
Practice Address - Country:US
Practice Address - Phone:361-649-1858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health