Healthcare Provider Details

I. General information

NPI: 1184528945
Provider Name (Legal Business Name): EAST COAST RESIDENTIAL INNOVATIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 PERSIMMON CT
JACKSONVILLE NC
28546-8258
US

IV. Provider business mailing address

PO BOX 12342
JACKSONVILLE NC
28546-2342
US

V. Phone/Fax

Practice location:
  • Phone: 910-750-2202
  • Fax:
Mailing address:
  • Phone: 910-750-2202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateNULL

VIII. Authorized Official

Name: VANESSA LASHAY MONK
Title or Position: MANAGING EMPLOYEE
Credential: LCSW-A
Phone: 910-750-2202