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General NPI Number Information
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NPI Number | 1306217500
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Entity Type | Organization
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Legal Business Name | COASTLINE RECOVERY LLC
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Dates
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Enumeration Date | 10/13/2015
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Last Update Date | 03/13/2018
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Provider Practice Location Address
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Address Line | 18377 BEACH BLVD STE 210
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92648-1349
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Country | US
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Telephone | 949-205-1065
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Fax | 714-388-3844
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Provider Business Mailing Address
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Address Line | 18377 BEACH BLVD STE 210
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92648-1349
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Country | US
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Telephone | 949-205-1065
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Fax | 714-388-3844
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Authorized Official
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Title or Position | VP OF OPERATIONS
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Name | JASON JACOBS
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Credential |
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Telephone | 949-345-5577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 300630BP
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 300630BP
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License Number State | CA
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