Organization
COASTAL ENTERPRISES OF WILMINGTON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DONALD LEON HOOVER BS, QP (IDD SERVICES COORDINATOR)
(910) 763-3424
Entity
Organization
Contact information
Practice address
1214 KIDDER ST, WILMINGTON, NC 28401-5918
(910) 763-3424
(910) 815-0367
Mailing address
1214 KIDDER ST, WILMINGTON, NC 28401-5918
(910) 763-3424
(910) 815-0367
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
MHL-065-099
NC
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MHL-065-099
MENTAL HEALTH LICENSE #
NC
Enumeration date
02/13/2007
Last updated
03/07/2019
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