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General NPI Number Information
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NPI Number | 1356779409
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Entity Type | Organization
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Legal Business Name | C4C COASTAL BEND INC,
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Dates
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Enumeration Date | 10/29/2013
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Last Update Date | 09/04/2014
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Provider Practice Location Address
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Address Line | 302 AVENUE D
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City | VICTORIA
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State | TX
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Zip | 77901-8529
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Country | US
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Telephone | 361-649-1858
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Fax |
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Provider Business Mailing Address
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Address Line | 7405 GREENBACK LN # 140
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City | CITRUS HEIGHTS
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State | CA
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Zip | 95621
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Country | US
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Telephone | 916-870-9590
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JILL ANN POWELL
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Credential |
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Telephone | 916-870-9590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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