Healthcare Provider Details

I. General information

NPI: 1922781350
Provider Name (Legal Business Name): COAST TO COAST MHS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2023
Last Update Date: 08/11/2023
Certification Date: 08/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 E OAK ST APT 3
ARCADIA FL
34266-4445
US

IV. Provider business mailing address

223 E OAK ST APT 3
ARCADIA FL
34266-4445
US

V. Phone/Fax

Practice location:
  • Phone: 239-652-0260
  • Fax: 239-652-0146
Mailing address:
  • Phone: 239-652-0260
  • Fax: 239-652-0146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: LARRY BEUER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 239-652-0260