Provider Demographics
NPI:1063161933
Name:COASTAL REHABILITATION & REGENERATIVE MEDICINE, LLC
Entity type:Organization
Organization Name:COASTAL REHABILITATION & REGENERATIVE MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:HUBER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:609-233-8064
Mailing Address - Street 1:6102 SANDEN RD NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52411-8026
Mailing Address - Country:US
Mailing Address - Phone:609-233-8064
Mailing Address - Fax:
Practice Address - Street 1:100 WATER GRANDE BLVD
Practice Address - Street 2:
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566-8162
Practice Address - Country:US
Practice Address - Phone:609-233-8064
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-19
Last Update Date:2022-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital