NPIMap

Organization Active NPI

Coastal Recovery, Inc.

  • Substance Abuse Rehabilitation Facility
  • Fountain Valley, CA
National Provider Identifier
1013459569
Registry record updated Dec 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
COASTAL RECOVERY, INC.
Practice address
11851 Wisteria Ave
Fountain Valley, CA 92708-2654
Phone
(949) 642-4150
Fax
(949) 642-3441
NPI assigned
Nov 15, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Marshall Anthony Eddy
Title
President
Phone
(949) 413-1390

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X Primary

Addresses

Primary practice location

11851 Wisteria Ave
Fountain Valley, CA 92708-2654

Mailing address

11851 Wisteria Ave
Fountain Valley, CA 92708-2654
Phone (949) 642-4150

National Provider Directory

National Provider Directory
Tax ID family
Pacific City Recovery2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1479168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1482364800000",
    "number": "1013459569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11851 WISTERIA AVE",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927082654",
            "telephone_number": "949-642-4150",
            "fax_number": "949-642-3441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11851 WISTERIA AVE",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927082654",
            "telephone_number": "949-642-4150",
            "fax_number": "949-642-3441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL RECOVERY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-15",
        "last_updated": "2016-12-22",
        "status": "A",
        "authorized_official_last_name": "EDDY",
        "authorized_official_first_name": "MARSHALL",
        "authorized_official_middle_name": "ANTHONY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "949-413-1390",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fountain Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.