Healthcare Provider Details

I. General information

NPI: 1578598793
Provider Name (Legal Business Name): COASTAL CARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 SE RIVERSIDE DR
STUART FL
34994-2502
US

IV. Provider business mailing address

6801 BRECKSVILLE RD STE 20 ATTN: DPC RK2-7
INDEPENDENCE OH
44131-5062
US

V. Phone/Fax

Practice location:
  • Phone: 772-221-2002
  • Fax: 772-223-5622
Mailing address:
  • Phone: 216-636-4969
  • Fax: 216-636-6036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number4102
License Number StateFL

VIII. Authorized Official

Name: MR. DENNIS LARAWAY
Title or Position: EXECUTIVE VP CHIEF FINANCE OFFICER
Credential:
Phone: 216-445-1343