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General NPI Number Information
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NPI Number | 1568705606
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Entity Type | Organization
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Legal Business Name | COASTAL LIVING LLC
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Dates
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Enumeration Date | 03/27/2013
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Last Update Date | 03/27/2013
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Provider Practice Location Address
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Address Line | 1275 N BANANA RIVER DR
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City | MERRITT ISLAND
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State | FL
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Zip | 32952-5788
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Country | US
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Telephone | 321-704-6190
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Fax | 407-386-6267
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Provider Business Mailing Address
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Address Line | 1800 33RD ST SUITE 200
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City | ORLANDO
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State | FL
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Zip | 32839-8852
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Country | US
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Telephone | 407-451-5894
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Fax | 407-386-6267
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ANDREA E FINES
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Credential | RN
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Telephone | 407-451-5894
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL11441
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License Number State | FL
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