Provider Demographics
NPI:1457553380
Name:COASTAL COMMUNITY ACTION, INC.
Entity Type:Organization
Organization Name:COASTAL COMMUNITY ACTION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:J
Authorized Official - Last Name:TRAVERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-223-1630
Mailing Address - Street 1:303 MCQUEEN BLVD
Mailing Address - Street 2:P.O. BOX 729
Mailing Address - City:NEWPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28570-8121
Mailing Address - Country:US
Mailing Address - Phone:252-223-1630
Mailing Address - Fax:252-223-1689
Practice Address - Street 1:303 MCQUEEN BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:NC
Practice Address - Zip Code:28570-8121
Practice Address - Country:US
Practice Address - Phone:252-223-1630
Practice Address - Fax:252-223-1689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services
Not Answered251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300007Medicaid
NC8300007KMedicaid