Healthcare Provider Details

I. General information

NPI: 1417741794
Provider Name (Legal Business Name): THE COALITION HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2025
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2434 LINCOLN BLVD
VENICE CA
90291-6034
US

IV. Provider business mailing address

2434 LINCOLN BLVD
VENICE CA
90291-6034
US

V. Phone/Fax

Practice location:
  • Phone: 224-307-0600
  • Fax:
Mailing address:
  • Phone: 224-307-0600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HAYDEN MOSER
Title or Position: BILLING DIRECTOR
Credential:
Phone: 949-446-6280