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General NPI Number Information
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NPI Number | 1871925495
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Entity Type | Organization
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Legal Business Name | EAST COAST HABILITATION OPTIONS
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Dates
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Enumeration Date | 08/06/2013
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Last Update Date | 08/06/2013
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Provider Practice Location Address
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Address Line | 17 BUFFALO PLAINS LN
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City | PALM COAST
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State | FL
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Zip | 32137-9458
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Country | US
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Telephone | 386-264-6953
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Fax | 386-264-6136
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Provider Business Mailing Address
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Address Line | 17 BUFFALO PLAINS LN
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City | PALM COAST
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State | FL
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Zip | 32137-9458
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Country | US
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Telephone | 386-264-6953
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Fax | 386-264-6136
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Authorized Official
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Title or Position | COO
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Name | MARYANN REITER
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Credential |
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Telephone | 386-983-2348
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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