Healthcare Provider Details

I. General information

NPI: 1922022607
Provider Name (Legal Business Name): COASTAL HORIZONS CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 SHIPYARD BLVD
WILMINGTON NC
28412-6431
US

IV. Provider business mailing address

615 SHIPYARD BLVD
WILMINGTON NC
28412-6431
US

V. Phone/Fax

Practice location:
  • Phone: 910-790-0187
  • Fax: 910-790-0189
Mailing address:
  • Phone: 910-790-0187
  • Fax: 910-790-0189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMHL-065-011
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License NumberMHL-065-011
License Number StateNC

VIII. Authorized Official

Name: MS. MARGARET WELLER STARGELL
Title or Position: PRESIDENT & CEO
Credential:
Phone: 910-790-0187