Organization
COASTAL CARE SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BARRY L GROS JR. (OWNER)
(504) 616-7902
Entity
Organization
Contact information
Practice address
1011 N CAUSEWAY BLVD, SUITE 35, MANDEVILLE, LA 70471-3243
(985) 674-2054
(985) 674-2053
Mailing address
1011 N CAUSEWAY BLVD, SUITE 35, MANDEVILLE, LA 70471-3243
(985) 674-2054
(985) 674-2053
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
CM 27024
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1802671
—
LA
Enumeration date
07/10/2012
Last updated
07/10/2012
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