Healthcare Provider Details

I. General information

NPI: 1912848698
Provider Name (Legal Business Name): COAST TO COAST HEALTH GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2026
Last Update Date: 04/26/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 NE STUCKI AVE STE 140B
HILLSBORO OR
97124-7107
US

IV. Provider business mailing address

3000 NE STUCKI AVE STE 140B
HILLSBORO OR
97124-7107
US

V. Phone/Fax

Practice location:
  • Phone: 503-461-4005
  • Fax:
Mailing address:
  • Phone: 503-461-4005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. MEREDITH MADDOX GALVIN
Title or Position: OWNER/PROVIDER
Credential: PMHNP-BC
Phone: 919-414-4644