Provider Demographics
NPI:1154166759
Name:COASTAL HAVEN LLC
Entity type:Organization
Organization Name:COASTAL HAVEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAIGLE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:508-306-1179
Mailing Address - Street 1:8 GURNET ROAD
Mailing Address - Street 2:SUITE 7, 1033
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011
Mailing Address - Country:US
Mailing Address - Phone:508-306-1179
Mailing Address - Fax:
Practice Address - Street 1:8 GURNET ROAD
Practice Address - Street 2:SUITE 7, 1033
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011
Practice Address - Country:US
Practice Address - Phone:508-306-1179
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-26
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty