Organization
COASTAL COMMUNITY ACTION, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. EDITH J TRAVERS (EXEVUTIVE DIRECTOR)
(252) 223-1630
Entity
Organization
Contact information
Practice address
303 MCQUEEN BLVD, NEWPORT, NC 28570-8121
(252) 223-1630
(252) 223-1689
Mailing address
PO BOX 729, 303 MCQUEEN AVE., NEWPORT, NC 28570-0729
(252) 223-1630
(252) 223-1689
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8300007
—
NC
05
—
8300007K
—
NC
Enumeration date
09/12/2007
Last updated
10/27/2007
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