Healthcare Provider Details

I. General information

NPI: 1154594950
Provider Name (Legal Business Name): COASTAL MENTAL HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2008
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BELLAGIO CIR
SANFORD FL
32771-5000
US

IV. Provider business mailing address

101 BELLAGIO CIR
SANFORD FL
32771-5000
US

V. Phone/Fax

Practice location:
  • Phone: 800-614-4124
  • Fax: 888-217-4124
Mailing address:
  • Phone: 407-712-4332
  • Fax: 888-217-4124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. TIMOTHY JOHN SCALETTA
Title or Position: CEO
Credential:
Phone: 800-614-4124