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General NPI Number Information
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NPI Number | 1184528945
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Entity Type | Organization
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Legal Business Name | EAST COAST RESIDENTIAL INNOVATIONS
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Dates
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Enumeration Date | 10/06/2026
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Last Update Date | 10/06/2026
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Provider Practice Location Address
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Address Line | 105 PERSIMMON CT
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City | JACKSONVILLE
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State | NC
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Zip | 28546-8258
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Country | US
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Telephone | 910-750-2202
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 12342
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City | JACKSONVILLE
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State | NC
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Zip | 28546-2342
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Country | US
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Telephone | 910-750-2202
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Fax |
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Authorized Official
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Title or Position | MANAGING EMPLOYEE
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Name | VANESSA LASHAY MONK
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Credential | LCSW-A
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Telephone | 910-750-2202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State | NULL
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Taxonomy #2
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number |
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License Number State | NULL
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Taxonomy #3
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State | NULL
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