Healthcare Provider Details

I. General information

NPI: 1306399159
Provider Name (Legal Business Name): COASTAL ADDICTION CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2016
Last Update Date: 07/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

947 S ANAHEIM BLVD STE 270
ANAHEIM CA
92805-5584
US

IV. Provider business mailing address

947 S ANAHEIM BLVD STE 270
ANAHEIM CA
92805-5584
US

V. Phone/Fax

Practice location:
  • Phone: 714-533-1491
  • Fax: 714-533-0237
Mailing address:
  • Phone: 714-533-1491
  • Fax: 714-533-0237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: DAVID T ASHER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 714-533-1491