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General NPI Number Information
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NPI Number | 1609583673
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Entity Type | Organization
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Legal Business Name | COASTAL TREATMENT CENTERS, LARGO
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Dates
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Enumeration Date | 10/31/2022
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Last Update Date | 10/31/2022
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Provider Practice Location Address
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Address Line | 2057 EDGEWATER DR
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City | CLEARWATER
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State | FL
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Zip | 33755-1028
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Country | US
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Telephone | 727-205-7077
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Fax |
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Provider Business Mailing Address
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Address Line | 28059 US HIGHWAY 19 N STE 205
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City | CLEARWATER
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State | FL
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Zip | 33761-2620
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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 | CHIEF COMPLIANCE OFFICER
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Name | ANDRE GENAO
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Credential |
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Telephone | 352-442-2643
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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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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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