Coastal Carolina Behavioral Healthcare, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

COASTAL CAROLINA BEHAVIORAL HEALTHCARE, LLC

Practice address

3806 Park Ave
Suite a
Wilmington, NC 28403-6738

Phone

(910) 392-0477

Fax

(910) 392-0447

NPI assigned

Jan 9, 2007

Organization subpart

No

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

Authorized official

Name

Laronda Woods-Freeman

Title

Director

Phone

(910) 392-0477

Specialties & licenses 1

Addresses

Other identifiers 6

Other names 1

• Circle of Courage Behavioral Healthcare Doing business as

Tax ID family

Circle of Courage Behavioral Healthcare2 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.

• Coastal Carolina Behavioral Healthcare, LLC

  • Community/Behavioral Health Agency
  • Fayetteville, NC
  • NPI 1790113520
  NPD tax ID

Locations

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

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1378425600000",
    "number": "1780733717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3806 PARK AVE",
            "address_2": "SUITE A",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284036738",
            "telephone_number": "910-392-0477",
            "fax_number": "910-392-0447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3806 PARK AVE",
            "address_2": "SUITE A",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284036738",
            "telephone_number": "910-392-0477",
            "fax_number": "910-392-0447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL CAROLINA BEHAVIORAL HEALTHCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-09",
        "last_updated": "2013-09-06",
        "status": "A",
        "authorized_official_last_name": "WOODS-FREEMAN",
        "authorized_official_first_name": "LARONDA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "910-392-0477"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8301226V",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8301226",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8301226H",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8301226B",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6604437",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3410191",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Circle of Courage Behavioral Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Behavioral Health Agency in Wilmington, NC
• Providers in Wilmington, NC by specialty
• Community/Behavioral Health Agency in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2013; 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.