NPIMap

Organization Active NPI

Coastal Family Health Center, Inc

Doing business as Coastal Family Health Center, Inc - Vancleave Upper Elementary Clinic

  • Federally Qualified Health Center (FQHC)
  • Vancleave, MS
National Provider Identifier
1871250993
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
Doing business as
Coastal Family Health Center, Inc - Vancleave Upper Elementary Clinic
Practice address
13901 Highway 57
Vancleave, MS 39565-8306
Phone
(228) 374-2494
NPI assigned
Nov 23, 2021
Last updated
Aug 16, 2024By the provider in NPPES
Organization subpart
No

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
Angelique Greer
Title
Ceo
Phone
(228) 374-2494

Specialties & licenses 1

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

Addresses

Primary practice location

13901 Highway 57
Vancleave, MS 39565-8306

Mailing address

10467 Corporate Dr
Gulfport, MS 39503-4634
Phone (228) 397-2494

Other names 1

  • Coastal Family Health Center, Inc - Vancleave Upper Elementary Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220531002804 MS Part A Provider - Federally Qualified Health Center (FQHC) 8628989654 Practice locations: Vancleave, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1871250993. Details of each certification follow.

Federally qualified health center certification: CCN 251127

Legal name
COASTAL FAMILY HEALTH CENTER, INC
Doing business as
COASTAL FAMILY HEALTH CENTER, INC-VANCLEAVE UPPER ELEMENTARY CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 25, 2022
Last certification
May 25, 2022
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Incorporated
Aug 25, 1979 in MS
Enrollment address
13901 Highway 57
Vancleave, MS 39565-8306

National Provider Directory

National Provider Directory
Tax ID family
Coastal Family Health C54 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 18

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

View all 18

Ownership & related parties

All disclosed owners & managing parties 13

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 Nov 1, 2021
Xuan Phan Individual Corporate Director Nov 1, 2021
Kwantrell D Green Individual Corporate Director Nov 1, 2021
Roy a Tolbert Individual Corporate Director Nov 1, 2021
Bertha J Oatis Individual Corporate Director Nov 1, 2021
Paulette T Briscoe Individual Corporate Director Nov 1, 2021
Christine M McLeod Individual Corporate Director Nov 1, 2021
Angelique S Greer Individual Corporate Director Nov 1, 2021
W-2 Managing Employee Nov 1, 2021
Xenia G Wickline Individual Corporate Director Nov 1, 2021
Jane Campbell Individual Corporate Director Jan 1, 2021
Coastal Family Health Center, Inc Organization, Vancleave, MS Non-profit Operational/Managerial Control Nov 1, 2021
Shelby Ward Individual Corporate Director Nov 1, 2021
Joseph P Hudson Individual Corporate Director Nov 1, 2021

All facility ownership & control disclosures 5

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

Facilities with the same owner 5

Facilities that share an organizational owner with 5% or greater ownership or operational control.

NPI Registry JSON

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

{
    "created_epoch": "1637625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723766400000",
    "number": "1871250993",
    "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": "228-397-2494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13901 HIGHWAY 57",
            "city": "VANCLEAVE",
            "state": "MS",
            "postal_code": "395658306",
            "telephone_number": "228-374-2494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL FAMILY HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-23",
        "last_updated": "2024-08-16",
        "certification_date": "2024-08-16",
        "status": "A",
        "authorized_official_last_name": "GREER",
        "authorized_official_first_name": "ANGELIQUE",
        "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 - Vancleave Upper Elementary Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Coastal Family Health Center, Inc - Vancleave Upper Elementary Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vancleave, MS

Sources for this page

Verify at the official NPI Registry.