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NPI Code Detail

MEDICARE: COASTAL BEHAVIOR HEALTH SERVICES, INC.

MEDICARE: COASTAL BEHAVIOR HEALTH SERVICES, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1320800000XMental Illness Community Based Residential Treatment Facility1720276868NC
2253J00000XFoster Care Agency1720276868NC
3251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1720276868
Entity Type Code : Organization
Provider Name (Legal Business Name) : COASTAL BEHAVIOR HEALTH SERVICES, INC.
Provider Business Mailing Address
First Line : 806 STAMPER RD STE 201
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28303-4100
Country : US
Telephone Number : 910-484-8869
Fax Number : 910-491-9703
Provider Business Practice Location Address
First Line : 806 STAMPER RD STE 201
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28303-4100
Country : US
Telephone Number : 910-484-8869
Fax Number : 910-491-9703
Authorized Official
Title or Position : EXECUTIVE DIRECTOR/CEO
Name : MRS. DUANA ANGELE MARSHALL
Credential : M.S., Q.P.
Telephone Number : 910-484-8869
Provider Enumeration Date : 10/12/2007
Last Update Date : 12/15/2015

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