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General NPI Number Information
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NPI Number | 1902611478
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Entity Type | Organization
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Legal Business Name | COAST TO COAST DIGNITY FOR VETS, INC.
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Dates
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Enumeration Date | 02/11/2025
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Last Update Date | 08/28/2025
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Provider Practice Location Address
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Address Line | 189 SAN MARCO AVE
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City | ST AUGUSTINE
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State | FL
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Zip | 32084-2733
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Country | US
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Telephone | 949-313-5210
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Fax | 727-363-6994
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Provider Business Mailing Address
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Address Line | PO BOX 9296
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City | LAGUNA BEACH
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State | CA
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Zip | 92652-7261
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Country | US
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Telephone | 949-313-5275
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Fax | 727-363-6994
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Authorized Official
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Title or Position | CHIEF OPERATIONS OFFICER
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Name | MR. CHARLES FRANCIS KANUTE
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Credential | B.S., CAS
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Telephone | 949-315-9225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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