Organization
COASTAL RECOVERY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARSHALL ANTHONY EDDY (PRESIDENT)
(949) 413-1390
Entity
Organization
Contact information
Practice address
11851 WISTERIA AVE, FOUNTAIN VALLEY, CA 92708-2654
(949) 642-4150
(949) 642-3441
Mailing address
11851 WISTERIA AVE, FOUNTAIN VALLEY, CA 92708-2654
(949) 642-4150
(949) 642-3441
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
11/15/2016
Last updated
12/22/2016
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