Organization
COASTAL RESIDENTIAL SERVICES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROL WILSON (VICE PRESIDENT)
(910) 938-9550
Entity
Organization
Contact information
Practice address
445 WESTERN BLVD STE T, JACKSONVILLE, NC 28546-6852
(910) 938-9550
(910) 346-9186
Mailing address
PO BOX 7128, JACKSONVILLE, NC 28540-2128
(910) 938-9550
(910) 346-9186
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
MHL-067-049
NC
251S00000X
Community/Behavioral Health Agency
MHL-067-052
NC
251S00000X
Community/Behavioral Health Agency
MHL-067-059
NC
251S00000X
Community/Behavioral Health Agency
Primary
MHL-067-085
NC
251S00000X
Community/Behavioral Health Agency
MHL-067-091
NC
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
MHL-067-052
NC
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
MHL-067-059
NC
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
MHL-067-091
NC
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
MHL-067049
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3408942
—
NC
05
—
3419231
—
NC
Enumeration date
08/29/2006
Last updated
11/18/2020
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