Organization
COASTAL CONCIERGE SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK ECKSTROM (MANAGER)
(772) 485-8931
Entity
Organization
Contact information
Practice address
2690 SE WILLOUGHBY BLVD, STUART, FL 34994-4700
(772) 485-8931
Mailing address
2690 SE WILLOUGHBY BLVD, STUART, FL 34994-4700
(772) 485-8931
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
L16000112704
DOCUMENT NUMBER
FL
Enumeration date
06/27/2016
Last updated
06/27/2016
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