NPIMap

Organization Active NPI

Coastal Family Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Kiln, MS
National Provider Identifier
1831970144
Registry record updated Aug 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COASTAL FAMILY HEALTH CENTER, INC
Practice address
4221 Kiln Delisle Rd
Kiln, MS 39556-6695
Phone
(228) 374-2494
Fax
(228) 396-3457
NPI assigned
Oct 12, 2023
Organization subpart
Yes
Parent organization
COASTAL FAMILY HEALTH CENTER, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 16, 2024

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

Authorized official

Name
Angleique Greer
Title
Ceo
Phone
(228) 374-2494

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

4221 Kiln Delisle Rd
Kiln, MS 39556-6695

Mailing address

10467 Corporate Dr
Gulfport, MS 39503-4634
Phone (228) 374-2494

Other names 1

  • Coastal Family Health Center, Inc - East Hancock Elementary School Cl Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040108000698 MS Part B Supplier - Clinic/Group Practice 8628989654 Receives reassigned benefits from 90 practitioners
37 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: MC Lain, MS; Moss Point, MS; Ocean Springs, MS; Pass Christian, MS; Richton, MS; State Line, MS; Vancleave, MS; Waveland, MS…
O20240125001422 MS Part A Provider - Federally Qualified Health Center (FQHC) 8628989654 Practice locations: Kiln, MS

Federally qualified health center certification: CCN 251159

Legal name
COASTAL FAMILY HEALTH CENTER, INC
Doing business as
CFHC - EAST HANCOCK ELEM
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 27, 2023
Last certification
Dec 27, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 25, 1978 in MS
Enrollment address
4221 Kiln Delisle Rd
Kiln, MS 39556-6695

Other NPIs on the same Medicare enrollment 37

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

View all 37

National Provider Directory

National Provider Directory
Tax ID family
Coastal Family Health Center54 organizations share this tax ID, including this one
Part of
Coastal Family Health Center

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

4221 Kiln Delisle Rd
Kiln, MS 39556
Phone (228) 586-9273

Ownership & related parties

All disclosed owners & managing parties 11

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Judy a Grant Individual Corporate Director Dec 13, 2023
Kwantrell D Green Individual Corporate Director Dec 13, 2023
Roy a Tolbert Individual Corporate Director Dec 13, 2023
Bertha J Oatis Individual Corporate Director Dec 13, 2023
Paulette T Briscoe Individual Corporate Director Dec 13, 2023
Christine M McLeod Individual Corporate Director Dec 13, 2023
Angelique S Greer Individual Corporate Director Dec 13, 2023
W-2 Managing Employee Dec 13, 2023
Xenia G Wickline Individual Corporate Director Dec 13, 2023
Jane Campbell Individual Corporate Director Dec 13, 2023
Shelby Ward Individual Corporate Director Dec 13, 2023
Joseph P Hudson Individual Corporate Director Dec 13, 2023

All facility ownership & control disclosures 6

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Coastal Family Health Center, Inc - North Bay Elementary School ClinicBay St Louis, MS, CCN 251120 Federally qualified health center Operational/Managerial Control Nov 1, 2021
Coastal Family Health Center, Inc - Bay High School ClinicBay St Louis, MS, CCN 251123 Federally qualified health center Operational/Managerial Control Nov 1, 2021
Coastal Family Health Center Inc - Waveland Elementary School ClinicWaveland, MS, CCN 251126 Federally qualified health center Operational/Managerial Control Nov 1, 2021
Coastal Family Health Center Inc - East Central Upper Elementary SchooMoss Point, MS, CCN 251125 Federally qualified health center Operational/Managerial Control Nov 1, 2021
Coastal Family Health Center Inc - Bay Waveland Middle SchoolBay St Louis, MS, CCN 251124 Federally qualified health center Operational/Managerial Control (100%) Feb 9, 2022
Coastal Family Health Center, Inc-Vancleave Upper Elementary ClinicVancleave, MS, CCN 251127 Federally qualified health center Operational/Managerial Control Nov 1, 2021

NPI Registry JSON

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

{
    "created_epoch": "1697068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723766400000",
    "number": "1831970144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10467 CORPORATE DR",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395034634",
            "telephone_number": "228-374-2494",
            "fax_number": "228-396-3457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4221 KILN DELISLE RD",
            "city": "KILN",
            "state": "MS",
            "postal_code": "395566695",
            "telephone_number": "228-374-2494",
            "fax_number": "228-396-3457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL FAMILY HEALTH CENTER, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COASTAL FAMILY HEALTH CENTER, INC",
        "enumeration_date": "2023-10-12",
        "last_updated": "2024-08-16",
        "certification_date": "2024-08-16",
        "status": "A",
        "authorized_official_last_name": "GREER",
        "authorized_official_first_name": "ANGLEIQUE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "228-374-2494"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coastal Family Health Center, Inc - East Hancock Elementary School Cl",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Coastal Family Health Center, Inc - East Hancock Elementary School Cl",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kiln, MS

Sources for this page

Verify at the official NPI Registry.