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Coastal Residential Services, Inc
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Jacksonville, North Carolina
NPI 1780792705

Coastal Residential Services, Inc is a Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility based in Jacksonville, NC. Coastal Residential Services, Inc practices in Jacksonville, NC. The NPI Number for Coastal Residential Services, Inc is 1780792705 and holds a License No. MHL-067-085 (North Carolina).

The current practice location address for Coastal Residential Services, Inc is 445 Western Blvd Ste T, Jacksonville, NC and can be reached out via phone at 910-938-9550 and via fax at 910-346-9186.

Location: 445 Western Blvd Ste T, Jacksonville, NC, 28540-2128
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1780792705
Provider Name
Coastal Residential Services, Inc
Credential
Provider Entity Type
Organization
Address
445 Western Blvd Ste T, Jacksonville, NC, 28540-2128
Phone Number
910-938-9550
Fax Number
910-346-9186
Provider Enumeration Date
08/29/2006
Last Update Date
03/12/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
3419231 05 NC
3408942 05 NC
institution
Provider Business Practice Location Address Details
Address
445 Western Blvd Ste T
City
Jacksonville
State
North Carolina
Zip
28546-6852
Phone Number
910-938-9550
Fax Number
910-346-9186
person
Provider Business Mailing Address Details
Address
445 Western Blvd Ste T
City
Jacksonville
State
North Carolina
Zip
28546-6852
Phone Number
910-938-9550
Fax Number
910-346-9186
person
Provider's Taxonomy Details 1
Type
Agencies
Classification
Community/Behavioral Health
Speciality
-
Taxonomy
251S00000X
License No.
MHL-067-052 (North Carolina)
Definition
A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment.
person
Provider's Taxonomy Details 2
Type
Residential Treatment Facilities
Classification
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Speciality
-
Taxonomy
320900000X
License No.
MHL-067-085 (North Carolina)
Definition
A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.
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