Provider Demographics
NPI:1700041753
Name:COASTAL HEALTHCARE SERVICES, INC
Entity Type:Organization
Organization Name:COASTAL HEALTHCARE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:QUIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-525-1641
Mailing Address - Street 1:3801 CONNECTICUT AVE NW # 100
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-4530
Mailing Address - Country:US
Mailing Address - Phone:202-525-1641
Mailing Address - Fax:
Practice Address - Street 1:3801 CONNECTICUT AVE NW # 100
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-4530
Practice Address - Country:US
Practice Address - Phone:202-525-1641
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-18
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty