Provider Demographics
NPI:1740099316
Name:FORGOTTEN COAST HEALING CENTER INC
Entity type:Organization
Organization Name:FORGOTTEN COAST HEALING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:CARMICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:850-660-9068
Mailing Address - Street 1:35 ISLAND DR STE 14
Mailing Address - Street 2:
Mailing Address - City:EASTPOINT
Mailing Address - State:FL
Mailing Address - Zip Code:32328-3264
Mailing Address - Country:US
Mailing Address - Phone:850-660-9068
Mailing Address - Fax:407-604-6346
Practice Address - Street 1:35 ISLAND DR STE 14
Practice Address - Street 2:
Practice Address - City:EASTPOINT
Practice Address - State:FL
Practice Address - Zip Code:32328-3264
Practice Address - Country:US
Practice Address - Phone:850-660-9068
Practice Address - Fax:407-604-6346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center