# COASTAL CARE CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Cleveland Clinic Imaging
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124751185
- **Authorized official:** TIMOTHY LONGVILLE (CHIEF ACCOUNTING OFFICER AND CONTRO)
- **Authorized official phone:** (216) 636-7416

## Contact information

- **Practice address:** 10000 SW INNOVATION WAY, PORT SAINT LUCIE, FL 34987-2111
- **Practice address phone:** (772) 345-5236
- **Mailing address:** 6801 BRECKSVILLE RD, STE 20, RK2-7, INDEPENDENCE, OH 44131
- **Mailing address phone:** (216) 636-4969

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1200X | Magnetic Resonance Imaging (MRI) Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 07/07/2022
- **Last updated:** 07/07/2022