Coastal Shores, Inc.

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

ALLS2967 Issued in ME

Legal business name

COASTAL SHORES, INC.

Doing business as

Coastal Shores

Practice address

142 Neptune Drive
Brunswick, ME 04011

Phone

(207) 725-5801

Fax

(207) 725-1404

NPI assigned

Jan 23, 2008

Last updated

Oct 7, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Mitchell A Rousseau

Title

President

Phone

(207) 725-4071

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Coastal Shores Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1201046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444176000000",
    "number": "1710164611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 BANK ST",
            "city": "BRUNSWICK",
            "state": "ME",
            "postal_code": "040111501",
            "telephone_number": "207-725-4071",
            "fax_number": "207-725-4424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "142 NEPTUNE DRIVE",
            "city": "BRUNSWICK",
            "state": "ME",
            "postal_code": "04011",
            "telephone_number": "207-725-5801",
            "fax_number": "207-725-1404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL SHORES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-23",
        "last_updated": "2015-10-07",
        "status": "A",
        "authorized_official_last_name": "ROUSSEAU",
        "authorized_official_first_name": "MITCHELL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "207-725-4071",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "ME",
            "license": "ALLS2967",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "432796300",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coastal Shores",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Coastal Maine Pediatric Dentistry
• Coastal Mental Health, PLLC
• Coastal Orthopedics & Sports Medicine
• Coastal Orthopedics & Sports Medicine,P.a. (Coastal Orthopedics & Sports Medicine)
• Coastal Orthopedics & Sports Medicine,P.a.
• Rebecca Sue Cobb-Castonguay, RDH, IPDH
• Robert Timothy Cochrane, MD
• Chadd Joseph Cockrell, DMD
• Timothy Howard Coffin, DC
• Chelsea Cogan, PHD

• Assisted Living Facility in Brunswick, ME
• Providers in Brunswick, ME by specialty
• Assisted Living Facility in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.