Healthcare Provider Details

I. General information

NPI: 1033350517
Provider Name (Legal Business Name): COASTAL OPPORTUNITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2009
Last Update Date: 06/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 LIMEROCK ST
CAMDEN ME
04843-2114
US

IV. Provider business mailing address

PO BOX 637
CAMDEN ME
04843-0637
US

V. Phone/Fax

Practice location:
  • Phone: 207-236-6008
  • Fax: 207-236-0690
Mailing address:
  • Phone: 207-236-6008
  • Fax: 207-236-0690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number37016
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberALLS 2969
License Number StateME
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateME

VIII. Authorized Official

Name: MR. JOSEPH CURLL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 207-236-6008