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General NPI Number Information
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NPI Number | 1871381509
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Entity Type | Organization
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Legal Business Name | COASTAL RECOVERY CONCEPTS INC
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Dates
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Enumeration Date | 04/30/2025
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 3434 GROVE ST
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City | LEMON GROVE
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State | CA
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Zip | 91945-1812
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Country | US
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Telephone | 619-782-0211
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Fax |
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Provider Business Mailing Address
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Address Line | 2358 UNIVERSITY AVE STE 371
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City | SAN DIEGO
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State | CA
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Zip | 92104-2720
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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 | ROGER STELLERS
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Credential |
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Telephone | 619-782-0011
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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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