Healthcare Provider Details

I. General information

NPI: 1982183273
Provider Name (Legal Business Name): COASTAL TREATMENT CENTER, NOKOMIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 08/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 TAMIAMI TRL N
NOKOMIS FL
34275-2120
US

IV. Provider business mailing address

119 TAMIAMI TRL N
NOKOMIS FL
34275-2120
US

V. Phone/Fax

Practice location:
  • Phone: 727-309-7993
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: CHRISTOPHER WRIGHT FOX
Title or Position: PRESIDENT
Credential:
Phone: 310-547-7501