NPIMap

Organization Active NPI

Coastal Southeastern United Care LLC

  • Community/Behavioral Health Agency
  • Bladenboro, NC
National Provider Identifier
1093032310
Registry record updated Jan 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
COASTAL SOUTHEASTERN UNITED CARE LLC
Practice address
818 S Main St
Suite 100-104
Bladenboro, NC 28320
Phone
(910) 863-4000
Fax
(910) 863-3169
NPI assigned
Apr 26, 2010
Last updated
Jan 27, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2020

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

Authorized official

Name
Ms. Stacy Williamson
Title
Director
Phone
(910) 755-5222

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

818 S Main St
Suite 100-104
Bladenboro, NC 28320

Mailing address

PO Box 1585
Shallotte, NC 28459-1585
Phone (910) 796-3350

Other practice location 1

30 Drakes Branch Dr
Pembroke, NC 28372-7325
Phone (910) 521-0092

Other practice location 2

100A Memory Plz
Whiteville, NC 28472-2640
Phone (910) 640-2230

Other practice location 3

401 W 27th St
Lumberton, NC 28358-3019
Phone (910) 370-0434

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121228000121 NC Part B Supplier - Clinic/Group Practice 6204089188 Receives reassigned benefits from 14 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bolivia, NC; Wilmington, NC; Whiteville, NC; Supply, NC; Shallotte, NC; Morehead City, NC; Lumberton, NC; Gastonia, NC

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

818 S Main St
Ste 100104
Bladenboro, NC 28320
Phone (910) 863-4000

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1272240000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580083200000",
    "number": "1093032310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1585",
            "city": "SHALLOTTE",
            "state": "NC",
            "postal_code": "284591585",
            "telephone_number": "910-796-3350",
            "fax_number": "910-796-3353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "818 S MAIN ST",
            "address_2": "SUITE 100-104",
            "city": "BLADENBORO",
            "state": "NC",
            "postal_code": "28320",
            "telephone_number": "910-863-4000",
            "fax_number": "910-863-3169"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "30 Drakes Branch Dr",
            "address_purpose": "LOCATION",
            "city": "Pembroke",
            "state": "NC",
            "postal_code": "283727325",
            "country_code": "US",
            "telephone_number": "910-521-0092",
            "fax_number": "910-521-0094",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100A Memory Plz",
            "address_purpose": "LOCATION",
            "city": "Whiteville",
            "state": "NC",
            "postal_code": "284722640",
            "country_code": "US",
            "telephone_number": "910-640-2230",
            "fax_number": "910-640-1625",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "401 W 27th St",
            "address_purpose": "LOCATION",
            "city": "Lumberton",
            "state": "NC",
            "postal_code": "283583019",
            "country_code": "US",
            "telephone_number": "910-370-0434",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "COASTAL SOUTHEASTERN UNITED CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-26",
        "last_updated": "2020-01-27",
        "certification_date": "2020-01-27",
        "status": "A",
        "authorized_official_last_name": "WILLIAMSON",
        "authorized_official_first_name": "STACY",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "910-755-5222",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bladenboro, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.