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General NPI Number Information
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NPI Number | 1316670961
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Entity Type | Organization
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Legal Business Name | COASTAL COVE OF KENANSVILLE LLC
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Dates
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Enumeration Date | 07/01/2022
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Last Update Date | 07/13/2022
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Provider Practice Location Address
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Address Line | 329 COOPER STREET
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City | KENANSVILLE
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State | NC
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Zip | 28349-2260
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Country | US
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Telephone | 520-437-1635
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Fax |
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Provider Business Mailing Address
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Address Line | 8480 HONEYCUTT RD STE 200-V88
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City | RALEIGH
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State | NC
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Zip | 27615-2260
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RAMARAJ RADHAKRISHNAN
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Credential | MD
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Telephone | 520-437-1635
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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