Organization
COASTAL HAVEN HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. WANDA DENISE WILSON (ADMINISTRATOR)
(910) 846-9196
Entity
Organization
Contact information
Practice address
399 DOE RUN DR., SUPPLY, NC 28462-6349
(910) 846-9196
Mailing address
1290 WINDY RIDGE TRL SW, P.O.OX 721, SUPPLY, NC 28462-3215
(910) 846-9196
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
04/16/2007
Last updated
06/27/2008
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