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General NPI Number Information
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NPI Number | 1982183273
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Entity Type | Organization
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Legal Business Name | COASTAL TREATMENT CENTER, NOKOMIS LLC
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Dates
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Enumeration Date | 08/08/2018
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Last Update Date | 08/08/2018
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Provider Practice Location Address
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Address Line | 119 TAMIAMI TRL N
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City | NOKOMIS
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State | FL
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Zip | 34275-2120
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Country | US
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Telephone | 727-309-7993
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Fax |
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Provider Business Mailing Address
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Address Line | 119 TAMIAMI TRL N
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City | NOKOMIS
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State | FL
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Zip | 34275-2120
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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 | PRESIDENT
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Name | CHRISTOPHER WRIGHT FOX
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Credential |
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Telephone | 310-547-7501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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